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.