How to Correctly Fill Out an MPI Application

How to Correctly Fill Out an MPI Application
Take your time and read all directions carefully.
Cover Page: Please fill out name and date on side of application and fill in the “Referred
By” section.
Page One: Please fill out entire application 100 percent to its entirety. Make sure to
circle an appropriate response to all questions asked. If you have not been in the military,
please write N/A. Include all speeding/traffic tickets, as well as any other arrests. (Not
parking tickets.)
Page Two: It is important to fill out ALL past Employment History for the last ten years,
even if you only worked there for a short time. Please do not leave any blanks. You can
ask for another Employment History sheet if needed or use additional sheets of paper
providing the same information.
Page Three: For Personal References, please list two people you have known for at least
one year, along with home, work and cell phone numbers. Do not list relatives. Read,
sign and date the Authorization, Release and Certification section.
Page Four: Please read Authorization for Release of Information and fill out all areas.
Page Five: Please read Disclosure Regarding Obtaining Consumer Report and/or
Investigative Consumer Report. Print and sign name and date.
Page Six: MPI Information. Please pull off and take this sheet with you.
It is very important to write legibly and fill out all areas of this application.
If you do not follow these directions, it may take longer to process your
application or the application may be rejected.
To submit your application on-line: Fill out this form on your computer.
When you have filled it out completely, click the "Submit" button on the last
page of the document.
To submit your application by mail: Print this form, then fill it out by hand
and mail to 2418 Crossroads Dr, Ste 1200, Madison WI 53718
Print Form
EMPLOYMENT APPLICATION
Online
__________________
Newspaper ________________
Employee _________________
2418 Crossroads Drive #1200
Madison WI 53718
608-243-7946
www.mpiprotective.com
___________
Date
Referred By:
_______________________________________
Applicant Name
Patrol Service
Investigations
Security Specialist
Alarm Response
Executive Protection
Critical Incident Response
Homeland Security
Security Professional Application
Important- Please Read:
Thank you for your interest in Midwest Patrol & Investigative, LLC. (“MPI”). MPI complies with all federal, state and local
employment laws and does not discriminate based on any protected characteristic or status. MPI’s policy requires that all people
interested in employment complete a written application. A resume alone is not sufficient. Applicants will be rejected if the
application isn’t filled out 100% to its entirety and excludes any of the following information: 1) Complete employment history
including phone numbers, dates of employment, company name, and reason for leaving, 2) Completed and signed authorizations for
background check 3) Signature of applicant 4) Complete and truthful response to all inquiries.
General Information
Date ___________________
Position Applied For: __________________________________ Telephone Number (
) _________________________________
Name: _____________________________________________________ Previous Names:__________________________________
(last)
(first)
(middle)
Address: ____________________________________________________________________________________________________
Please list your previous addresses in the last 5 years:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Have you ever pleaded guilty to or been convicted of a misdemeanor, felony, or ordinance violation or other offense (including
military court-martials)? Yes No
If yes, provide further information as to the offense(s), date, location of court, etc. Include traffic convictions. MPI will consider your record only as
it may substantially relate to, or as otherwise permitted by law. Attach additional sheets if necessary.
Year
County/State
Violation
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Are you subject to any pending criminal charges? Yes No
If yes, you must report each pending charge. MPI will consider the charge only as it may substantially relate to the job for which you are
applying.
Year
County/State
Charge
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Please circle response:
Are you a U.S. citizen or otherwise currently authorized to obtain lawful employment in this country? Yes No
Are you currently employed? Yes No
May we contact your current employer? Yes No
Type of employment desired? Full Time Part Time Location __________________
Have you applied with us before? Yes No If yes, when? ___________
Pay-Rate Desired___________________
Educational Background
# Credits Earned
High School _______________________
College ___________________________
Other _____________________________
_______________
_______________
_______________
List
ofservice
servicerequired”)
required”)
List U.S.
U.S. Military
Military Service
Service (“Verification
(“Verification of
Branch: __________ Rank:
Rank:__________ Dates
Datesof
ofService:
Service:__________________
Branch:
Major
Did you graduate?
___________ Yes No
___________ Yes No
___________ Yes No
1
War Veteran? __________________ If yes, Dates/Location:__________________________________________________________
Dates/Location:
List special
specialtraining
trainingor
oreducation
educationyou
youreceived:
received:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
__________________________________________________________________________________________
Employment History- Please note: resumes are welcome but cannot be used as a substitute for the information below. Please list
your employment history for the past 10 years. Attach additional pages if necessary. An applicant will not be considered for
employment if any of the required information is not submitted, or if any of the information is incorrect. Please print all information
legibly.
Employer ________________________Telephone (___)____________Dates Employed: From _____ To_____
Address_____________________________________ Job Title_____________________Rate of Pay $_______
Immediate Supervisor & Title_______________________Summarize Job Responsibilities_________________
__________________________________________________________________________________________
Reason for Leaving __________________________________________________________________________
Employer ________________________Telephone (___)_____________Dates Employed: From _____ To ____
Address_____________________________________ Job Title_____________________Rate of Pay $_______
Immediate Supervisor & Title_______________________Summarize Job Responsibilities_________________
__________________________________________________________________________________________
Reason for Leaving __________________________________________________________________________
Employer ________________________Telephone (___)_____________Dates Employed: From _____ To ____
Address_____________________________________ Job Title_____________________Rate of Pay $_______
Immediate Supervisor & Title_______________________Summarize Job Responsibilities_________________
__________________________________________________________________________________________
Reason for Leaving __________________________________________________________________________
Employer ________________________Telephone (___)_____________Dates Employed: From _____ To ____
Address_____________________________________ Job Title_____________________Rate of Pay $_______
Immediate Supervisor & Title_______________________Summarize Job Responsibilities_________________
__________________________________________________________________________________________
Reason for Leaving __________________________________________________________________________
Personal References: Please list the names along with home and work phone numbers of 2 people you have known at least one
year. Do not list relatives.
1._______________________________________________________________________________________________________
2._______________________________________________________________________________________________________
AUTHORIZATION, RELEASE AND CERTIFICATION
I certify that all information on this application is true, complete and correct to the best of my
knowledge. I understand that any false or misleading statements by me, or material omissions of
information requested of me, may result in rejection of my application or, if employed, my immediate
dismissal.
I hereby give permission to the employer to seek and to verify and supplement the information set
forth in the application. I release from all liability or legal claims that every person seeking or providing
information, whether oral or written. A photocopy of this release shall be as valid as the original, and may
be relied upon by all persons providing information.
I understand that employment with this employer is not contractual and is at-will. I understand and
agree that, if hired; I may voluntarily leave employment at any time, and may be terminated at any time
without prior notice for any reason, or for no reason. I understand that any oral or written statements which I
may claim to have been made to me now or in the future inconsistent with the provisions of this paragraph,
are expressly disavowed and revoked by the company, and should not be relied upon by me as an applicant
for employment or as an employee, if hired.
I understand that I may be required to submit to a medical examination if offered a position
conditioned on such examination. I also understand that I may be required to submit for testing for
controlled substances or other drugs.
I understand this application will be considered inactive after sixty (60) days. If I have not been hired
by MPI within such time, and if I am still interested in employment with MPI, I understand that I will need
to re-apply.
I certify that I have read (or have had read to me) and understand this authorization, release and
certification.
I Agree
Signature of Applicant___________________________________________ Date___________________________
PLEASE SCROLL DOWN TO COMPLETE THE FOLLOWING PAGES
THIS IS YOUR FORM TO KEEP
THANK YOU FOR YOUR INTEREST IN MPI!
Excellent Benefits
MPI depends on highly motivated, professional employees. We consider employee compensation an
important part of our quality service. We offer the following benefits:
• Top wages paid in the industry
• Training Subsidies
• Full Medical Coverage
• Long Term Life Insurance
• 401 (k) Plan
• Paid Vacation
• Fitness Club Subsidies
• Exceptional Advancement Opportunities
• AFLAC
These rewards provide employees with the opportunities and flexibility necessary to further their careers, in
a framework that suits their work goals, personal interests, and family needs. If you are interested in
beginning a career today that can grow with you in the future, we encourage you to look into becoming part
of MPI’s team.
MPI Training
Our in house staff of certified instructors provides MPI, the public and other police entities with an
excellent opportunity to access exceptional training at little or no cost to them. Training consists of:
• Defense and Arrest Tactics
• CPR & First Aid
• Firearms
• Executive Protection
• Disaster Recovery / Critical Incident Response
• Pepper Spray
• Tactical Training
• Homeland Security
MPI offers Public Safety Seminars, the Development of Workplace Violence Response Teams, Disaster
Recovery Training, as well as additional classes to keep our security professionals up to date, responsive,
professional and far exceeding minimum state standards.
Authorization for Release of Information
(For official use only, not to be released to unauthorized persons)
I hereby empower an employee of Midwest Patrol & Investigative, LLC, or other authorized
representative thereof bearing this release to obtain information and records pertaining to me from any
or all of the following sources:
1. Municipal, State or Federal law enforcement agencies
2. Selective Service System
3. Any banking institution
4. Any place of business
5. Credit rating bureaus or institutions maintaining individual credit rating files
6. Any previous employer
7. Present employer
8. Any school, college, university or other educational institution
9. Any law enforcement certification or licensing board of Wisconsin or any other state.
Exceptions to this blanket authorization are as follows:
1. Any medical information in the possession of any source named above until subsequent to a
conditional offer of employment (per Americans with Disabilities Act).
2. ___________________________________________________________
This release is executed to authorize Midwest Patrol & Investigative, LLC., as a prospective employer,
to obtain the above information. It is understood that said information shall be used only in
consideration of my employment and shall not be further disseminated for any purpose.
____________________________________
Date
I Agree
______________________________
Signature (Full Name)
___ / ___ / ___
Date of Birth ∗
___/ ___/ ___
Social Security Number*
___________________________________________
Address (Street and Number)
___________________________________________
City
∗
State Zip
Date-of-Birth and Social Security Number information will be used only to verify that information obtained pertains to the
Applicant. It will not be used as a factor in connection with any employment-related decision.
DISCLOSURE REGARDING OBTAINING CONSUMER REPORT
AND/OR INVESTIGATIVE CONSUMER REPORT
As part of its employment policy, MPI Protective Service, LLC. (“MPI”) may obtain a
consumer report or an investigative consumer report for the purpose of evaluating you for
employment, promotion, reassignment or retention as an employee. This report may include
information as to your character, general reputation, personal characteristics and mode of
living. The inquiry may include, but is not limited to: conviction record, motor vehicle
record, credit check, and references.
You have the right to request additional disclosures under federal law, including a summary
of rights under the Fair Credit Reporting Act. Upon your request, made within a reasonable
time, MPI will disclose the nature and scope of the investigation requested. MPI will send
this information within 5 business days of receiving your written notice.
This disclosure is made pursuant to the Federal Credit Reporting Act, 15 U.S.C. 1681(d).
AUTHORIZATION TO OBTAIN CONSUMER REPORT
AND/OR INVESTIGATIVE CONSUMER REPORT
I authorize MPI to obtain a consumer report and/or investigative consumer report for the
purpose of evaluating me for employment, promotion, reassignment or retention as an
employee. I understand that the inquiry may include, but is not limited to: conviction record,
motor vehicle record, credit check, and references. I understand and confirm that this
notification and authorization has been read and understood by me and that it becomes a part
of the employment application.
I Agree
Name of Authorizing Applicant (please print) Signature of Authorizing Applicant
Date
This authorization is given pursuant to the Fair Credit Reporting Act, 15 U.S.C.
1681b(b)(2).
Submit By Email
Print Form
070048-1ddb-260207mcp
Disclosure form
Click this button to submit your completed application on-line now.
Click this button to print a copy of this form for your own records.