Confidential

Application
for Employment
We appreciate your interest in Safe Storage Management Co. and assure you that we are
sincerely interested in your qualifications. A clear understanding of your background and work
history will help us potentially place you in a position that meets your objectives and those of
the Safe Storage. Qualified applicants are considered for all positions without regard to race,
color, religion, sex, national orientation, age, marital status, veteran status, gender identity,
sexual orientation, or the presence of a non-job related medical condition or disability.

EQUAL OPPORTUNITY EMPLOYER

1818 Mt. Diablo Blvd.

Walnut Creek, CA 94596
Tel: (925) 988-0804 Fax: (925) 988-0897
www.safestorageusa.com

SS Employment Application BAWP Version 1.1

Safe Storage Management Co.

Hiring Process
Before being hired by Safe Storage Management Co., all new hire candidates undergo the
following process prior to the start of a 90-day probation period for all new employees.

Application
Submit a completed application (and resume if one is
available) in response to Safe Storage advertisement

Interview No. 1
Hiring Manager conducts a telephone or one-on-one
qualifying interview

Interview No. 2
Candidate visits Human Resources Manager at
Safe Storages Walnut Creek administrative office

Interview No. 3
Second interview with two Safe Storage senior managers
and hiring manager

Interview No. 4
Final interview with Safe Storage personnel

Employment Offer
Submission of Offer Letter to final candidate by Safe Storage

Hire
New hire begins a 90-day probation period

SS Employment Application BAWP Version 1.1

DATE OF APPLICATION

P E R S O N AL IN F OR M A TI ON
(FULL LEGAL NAME)

LAST NAME

FIRST NAME

MIDDLE NAME

SOCIAL SECURITY NUMBER

HAVE YOU EVER USED ANOTHER NAME? YES NO

INDICATE ANY OTHER NAMES: ALIASES, MAIDEN NAMES, ETC.
HOME TELEPHONE NUMBER

MOBILE TELEPHONE NUMBER

E-MAIL ADDRESS

PRESENT STREET ADDRESS

CITY

STATE

ZIP CODE

MAILING ADDRESS, IF DIFFERENT THAN PHYSICAL ADDRESS

CITY

STATE

ZIP CODE

DRIVERS LICENSE NUMBER (CA I.D. NOT SUFFICIENT)

STATE

EXPIRATION DATE

IF HIRED, ARE YOU ABLE TO PROVIDE PROOF YOU ARE LEGALLY ABLE TO
WORK IN THE UNITED STATES?

DATE OF BIRTH

DO YOU HAVE A CLEAN DRIVING RECORD? YES NO

IF NO, PLEASE EXPLAIN

YES NO

EDUC ATI ON, TRAINI NG, U.S. MI LI TARY SERVI CE

TYPE OF SCHOOL

NAME AND CITY OF SCHOOL

NO. OF MONTHS AND/OR

YEARS COMPLETED

DID YOU GRADUATE?

HIGH SCHOOL

YES NO

TRADE / BUSINESS SCHOOL

YES NO

COLLEGE

YES NO

OTHER TRAINING (EXPLAIN)

YES NO

OTHER TRAINING (EXPLAIN)

YES NO

GED, DIPLOMA, DEGREE, LICENSE,

CERTIFICATE RECEIVED, IF ANY

MAJOR FIELD OF STUDY

ARE YOU PRESENTLY TAKING ANY EDUCATIONAL COURSES? YES NO

IF YES, WHAT AND WHERE?
HAVE YOU SERVED IN THE U.S. ARMED SERVICES? YES NO
IF YES, INDICATE MILITARY DUTIES AND TRAINING

S P E CI A L SKI LL S
PLEASE INDICATE LANGUAGES OTHER THAN ENGLISH THAT YOU:

SPEAK FLUENTLY

READ

WRITE

ARE YOU ABLE TO OPERATE A PERSONAL COMPUTER? YES NO

IF YES, WHAT TYPES OF SOFTWARE CAN YOU USE WITH PROFICIENCY?

INDICATE OFFICE MACHINES YOU ARE ABLE TO OPERATE

SPECIFIC SKILLS AND TRAINING WHAT KNOWLEDGE, SPECIAL SKILLS AND/OR INDIVIDUAL CAPABILITIES DO YOU HAVE WHICH ESPECIALLY PREPARE YOU FOR THE POSTION?

SS Employment Application BAWP Version 1.1

S A F E S T O RA G E E M PL OY M E N T
POSITION FOR WHICH YOU ARE APPLYING

SALARY AND BENEFITS DESIRED

HAVE YOU EVER APPLIED FOR WORK AT SAFE STORAGE BEFORE?

YES NO
IF YES, DATE AND POSITION APPLIED FOR

INDICATE NAMES OF FRIENDS OR RELATIVES EMPLOYED BY SAFE STORAGE

HAVE YOU EVER BEEN EMPLOYED BY SAFE STORAGE IN THE PAST? YES NO
IF YES, GIVE DATES OF EMPLOYMENT
HOW DID YOU HEAR ABOUT THIS POSITION?
NEWSPAPER ADVERTISEMENT

INTERNET ADVERTISEMENT

FRIEND/RELATIVE REFERRAL

EMPLOYEE REFERRAL

OTHER, PLEASE EXPLAIN:

PLEASE STATE WHY YOU ARE INTERESTED IN THIS JOB, DESCRIBING ITS RELEVANCE TO YOUR LIFE EXPERIENCE, SKILLS AND PERSONAL QUALITIES

AVAILABILITY
DATE AVAILABLE TO BEGIN WORK

HOURS AVAILABLE TO WORK

ARE YOU CURRENTLY EMPLOYED?

YES NO
DAYS AVAILABLE TO WORK
M

DO YOU HAVE A PART-TIME OR

EVENING JOB YOU INTEND TO
CONTINUE? YES NO

TH

IF SO, MAY WE CONTACT YOUR EMPLOYER?

YES NO

TYPE OF WORK FOR WHICH ARE YOU APPLYING

SU

PART-TIME

FULL-TIME

IF YES, GIVE DETAILS

CAN YOU WORK OVERTIME?

YES NO

WE COMPLY WITH THE AMERICANS WITH DISABILITIES ACT AND

CONSIDER REASONABLE ACCOMMODATION MEASURES THAT MAY
BE NECESSARY FOR ELIGIBLE APPLICANTS TO PERFORM
ESSENTIAL FUNCTIONS. ARE YOU ABLE TO PERFORM THE
ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING
WITH OR WITHOUT REASONABLE ACCOMMODATION? YES NO

A D D I T I ON AL I N F O R M A TIO N
PLEASE INDICATE ANY JOB-RELATED ORGANIZATIONS, CLUBS, PROFESSIONAL SOCIETIES, OR OTHER ASSOCIATIONS TO WHICH YOU BELONG (YOU MAY OMIT THOSE WHICH INDICATE YOUR
RACE, RELIGIOUS CREED, COLOR, NATIONAL ORIGIN, ANCESTRY, SEX OR AGE)

HAVE YOU BEEN DISMISSED OR ASKED TO RESIGN FROM ANY POSITION? YES NO IF YES, PLEASE EXPLAIN, PROVIDING DETAILS, INCLUDING THE REASONS GIVEN FOR YOUR DISMISSAL.

HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR OR FELONY? PLEASE DO NOT LIST THOSE CONVICTIONS WHICH HAVE BEEN SEALED, EXPUNGED, STATUTORILY ERADICATED, OR ANY
OTHER DISMISSAL AND/OR DISCHARGE. A CONVICTION WILL NOT NECESSARILY DISQUALIFY YOU FOR EMPLOYMENT. YES NO IF YES, PLEASE EXPLAIN.

PERSONAL AND PROF ESSION AL REFERENCES

PLEASE LIST 4 NON-RELATIVES WHO ARE QUALIFIED TO COMMENT ON YOUR CAPABILITIES AND CHARACTER, INCLUDING AT LEAST ONE PROFESSIONAL REFERENCE
NAME

TELEPHONE NUMBER

RELATIONSHIP

OCCUPATION

NO. OF YEARS KNOWN

EMERGENCY C ONTACT I NF ORMATION

NAME

TELEPHONE NUMBER

ADDRESS

CITY, STATE

E-MAIL

ZIP CODE

RELATIONSHIP

SS Employment Application BAWP Version 1.1

E M P L O Y M EN T H I S T O RY
ACCOUNT FOR ALL EMPLOYMENT WITHIN THE LAST 7 YEARS, BEGINNING WITH YOUR CURRENT OR MOST RECENT EMPLOYER. INDICATE EXPERIENCE THAT YOU BELIEVE
IS RELEVANT TO THE POSITION FOR WHICH YOU ARE APPLYING (E.G. VOLUNTEER EXPERIENCE, ETC.). ATTACH AN ADDITIONAL SHEET, IF NECESSARY.
COMPANY NAME

DATE EMPLOYED FROM

DATE EMPLOYED TO

STARTING SALARY

ENDING SALARY

ADDRESS

CITY, STATE

TELEPHONE NUMBER

SUPERVISOR

MAY WE CONTACT THIS

EMPLOYER?
YES NO

JOB TITLE

HOURS WORKED

IS THIS YOUR CURRENT

EMPLOYER?
YES NO

REASON FOR LEAVING

COMPANY NAME

DATE EMPLOYED FROM

DATE EMPLOYED TO

STARTING SALARY

ENDING SALARY

ADDRESS

CITY, STATE

TELEPHONE NUMBER

SUPERVISOR

MAY WE CONTACT THIS

EMPLOYER?
YES NO

JOB TITLE

HOURS WORKED

REASON FOR LEAVING

COMPANY NAME

DATE EMPLOYED FROM

DATE EMPLOYED TO

STARTING SALARY

ENDING SALARY

ADDRESS

CITY, STATE

TELEPHONE NUMBER

SUPERVISOR

MAY WE CONTACT THIS

EMPLOYER?
YES NO

JOB TITLE

HOURS WORKED

REASON FOR LEAVING

COMPANY NAME

DATE EMPLOYED FROM

DATE EMPLOYED TO

STARTING SALARY

ENDING SALARY

ADDRESS

CITY, STATE

TELEPHONE NUMBER

SUPERVISOR

MAY WE CONTACT THIS

EMPLOYER?
YES NO

JOB TITLE

HOURS WORKED

REASON FOR LEAVING

COMPANY NAME

DATE EMPLOYED FROM

DATE EMPLOYED TO

STARTING SALARY

ENDING SALARY

ADDRESS

CITY, STATE

TELEPHONE NUMBER

SUPERVISOR

MAY WE CONTACT THIS

EMPLOYER?
YES NO

JOB TITLE

HOURS WORKED

REASON FOR LEAVING

SPECIFIC JOB DUTIES

SPECIFIC JOB DUTIES

SPECIFIC JOB DUTIES

SPECIFIC JOB DUTIES

SPECIFIC JOB DUTIES

SS Employment Application BAWP Version 1.1

PERI ODS OF UN EMPL OY MEN T

PLEASE ACCOUNT FOR ALL PERIODS OF UNEMPLOYMENT WITHIN THE LAST 7 YEARS, BEGINNING WITH YOUR MOST RECENT PERIOD OF UNEMPLOYMENT.
FROM

TO

REASON FOR UNEMPLOYMENT

FROM

TO

REASON FOR UNEMPLOYMENT

FROM

TO

REASON FOR UNEMPLOYMENT

DATES UNEMPLOYED:

DATES UNEMPLOYED:

DATES UNEMPLOYED:

P L E A S E N OT E

INCOMPLETE OR INCORRECT INFORMATION COULD DISQUALIFY AN APPLICANT.

ALL QUESTIONS MUST BE ANSWERED IN FULL.
DO NOT INDICATE REFER TO RESUME. APPLICATIONS WITH THIS STATEMENT WILL NOT BE PROCESSED.
PLEASE NOTE AN OFFER OF EMPLOYMENT IS CONDITIONAL UPON A PRE-EMPLOYMENT BACKGROUND CHECK, MEDICAL EXAM AND DRUG SCREEN TEST.
THIS APPLICATION IS VALID FOR NINETY (90) DAYS FROM THE DATE OF YOUR SIGNATURE. A NEW APPLICATION MUST BE SUBMITTED AFTER 90 DAYS TO BE CONSIDERED FOR ADDITIONAL
JOB OPENINGS.
WE ARE AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER, DEDICATED TO A POLICY OF NONDISCRIMINATION IN EMPLOYMENT ON THE BASIS OF RACE, COLOR, RELIGION, SEX,
NATIONAL ORIGIN, AGE, SEXUAL ORIENTATION, OR MENTAL AND/OR PHYSICAL DISABILITY.
PROBATIONARY PERIOD: NEW EMPLOYEES WILL BE CONSIDERED TRIAL EMPLOYEES FOR AT LEAST 90 DAYS BEFORE ATTAINING REGULAR STATUS.

A P P L IC AN T A U T H O RI Z AT I ON AND GEN E R A L R EL E A S E
I HEREBY AUTHORIZE SSMCo. AND ADPSELECT (HEREIN KNOWN AS AGENT) TO REQUEST AND RECEIVE ANY AND ALL BACKGROUND INFORMATION ABOUT OR CONCERNING ME, INCLUDING
BUT NOT LIMITED TO MY CRIMINAL HISTORY, CREDIT HISTORY (INCLUDING A CONSUMER REPORT UNDER THE FAIR CREDIT REPORTING ACT, 15 U.S.C. 1681, ET SEQ. [THE ACT]), DRIVING
RECORD, EMPLOYMENT HISTORY, LANDLORD/TENANT HISTORY, CIVIL LISTINGS, EDUCATIONAL BACKGROUND, PROFESSIONAL LICENSE FROM ANY INDIVIDUAL, CORPORATION, PARTNERSHIP,
LAW ENFORCEMENT AGENCY, INSTITUTION, SCHOOL, ORGANIZATION, CREDIT BUREAU, STATE BOARD, LICENSING AGENCY, AND OTHER ENTITIES INCLUDING MY PRESENT AND PAST
EMPLOYERS.
I FURTHER RELEASE AND DISCHARGE SSMCo. AND ITS AGENT ADPSELECT, AND ALL OF THEIR COMBINED SUBSIDIARIES, AFFILIATES, OFFICERS, EMPLOYEES, CONTRACT PERSONNEL OR
ASSOCIATES, FROM ANY AND ALL CLAIMS AND LIABILITY ARISING OUT OF ANY REQUESTS FOR, OR RECEIPT OF, INFORMATION OR RECORDS PURSUANT TO THIS AUTHORIZATION, PROCUREMENT
OF AN INVESTIGATIVE CONSUMER REPORT, AND UNDERSTAND THAT IT MAY CONTAIN INFORMATION ABOUT MY CHARACTER, GENERAL REPUTATION, PERSONAL CHARACTERISTICS, AND MODE
OF LIVING, WHICHEVER ARE APPLICABLE.
I UNDERSTAND THAT I HAVE THE RIGHT TO MAKE WRITTEN REQUEST WITHIN A REASONABLE PERIOD OF TIME TO THE ORIGINAL PROVIDER OF CONSUMER INFORMATION FOR ADDITIONAL
INFORMATION CONCERNING THE NATURE AND SCOPE OF THIS INVESTIGATION. I ACKNOWLEDGE THAT I HAVE VOLUNTARILY PROVIDED THE ABOVE INFORMATION FOR EMPLOYMENT
APPLICATION PURPOSES, AND I HAVE CAREFULLY READ AND UNDERSTAND THIS AUTHORIZATION.
SIGNATURE

DATE

C ON S EN T FOR D RU G AN D ALC OHOL S C REEN TES T IN G

I HAVE BEEN FULLY INFORMED BY SSMCo. OF THE REASONS FOR THIS URINE TEST FOR DRUG AND/OR ALCOHOL. I UNDERSTAND WHAT I AM BEING TESTED FOR, THE PROCEDURE INVOLVED,
AND DO HEREBY FREELY GIVE MY CONSENT. IN ADDITION, I UNDERSTAND THAT THE RESULTS OF THIS TEST WILL BE FORWARDED TO SSMCo. AND BECOME PART OF MY RECORD. IF THIS TEST
RESULT IS POSITIVE AND FOR THIS REASON I AM NOT HIRED, I UNDERSTAND THAT I WILL BE GIVEN THE OPPORTUNITY TO EXPLAIN THE RESULTS OF THIS TEST.
I HEREBY AUTHORIZE THESE TEST RESULTS TO BE RELEASED TO:

NAME

SIGNATURE

DATE

A C KN OWL ED G M EN T
I HAVE READ AND UNDERSTAND ALL PROVISIONS OF THIS APPLICATION.
BY SIGNING THIS APPLICATION, I HOLD SSMCo. HARMLESS FOR ANY RESULT OF SSMCo. QUESTIONING REFERENCES PROVIDED IN THIS APPLICATION.
I HEREBY CERTIFY THAT THE ABOVEMENTIONED INFORMATION IS TRUE, COMPLETE AND CORRECT. I ACCEPT THAT, IN THE EVENT OF MY HIRE, ANY INFORMATION FOUND TO THE CONTRARY

MAY LEAD TO IMMEDIATE DISMISSAL.

ALL RELEVANT INFORMATION TO ASSIST IN MY APPLICATION HAS BEEN DISCLOSED.
I UNDERSTAND THIS APPLICATION DOES NOT REPRESENT A CONTRACT FOR EMPLOYMENT.
I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION.
I CERTIFY THAT I HAVE BEEN GIVEN A GENERAL OVERVIEW OF DUTIES AND RESPONSIBILITIES OF THE POSITION FOR WHICH I HAVE APPLIED.
I UNDERSTAND THAT NO REPRESENTATIVE FROM SSMCo. HAS ANY AUTHORITY TO ENTER INTO ANY SPECIAL AGREEMENT WITH ME, TO PROMISE AND/OR GUARANTEE MY EMPLOYMENT FOR
ANY SPECIFIC TIME PERIOD EITHER PRIOR TO COMMENCEMENT OF EMPLOYMENT OR AFTER I HAVE BECOME EMPLOYED, OR TO ASSURE ME OF ANY BENEFITS OR TERMS AND CONDITIONS
OF EMPLOYMENT, OR TO MAKE ANY AGREEMENT CONTRARY TO THE AFOREMENTIONED.

SIGNATURE

DATE

THANK YOU FOR YOUR INTEREST IN WORKING AT SAFE STORAGE! HAND DELIVER YOUR SIGNED APPLICATION TO A SAFE STORAGE MANAGER.
YOU WILL RECEIVE A RESPONSE IN REGARDS TO YOUR APPLICATION FROM A SAFE STORAGE REPRESENTATIVE WITHIN TWO WEEKS OF ITS SUBMITTAL.

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SS Employment Application BAWP Version 1.1