Fugitive Apprehension Specialist Team

A Division of Surety Solutions, LLC www.suretysolutions.us

AN EQUAL OPPORTUNITY EMPLOYER APPLICATION

Please Print

Date: __________________

Name: ___Oscar Goines__________________________________________________________ Present Address : ___4262 Knollcroft Road Dayton, OH 45426 ________________________________________________________________ No. Street City State Zip Home Phone No. (937___)__248______-__3738_______ Cell Phone No.(___)_______-_________ Do you have the legal right to work in the U.S. ? Do you have a valid operators (drivers) license? Have you ever been convicted of a sex offense ? Yes Yes Yes No No No No

Have you been convicted of a Felony within the past 5 years ? Yes

Please enter your National Association of Fugitive Recovery Agents Registration #:______________ Are you willing to submit to drug screening & a criminal history check ? Yes No

Do you have a health condition that would prevent you from doing this work with reasonable accommodation ? Yes No

MILITARY SERVICE RECORD

Have you ever serviced in the Armed Forces? Yes No

If yes, what branch? _________________________________________________________________ Dates of duty: From: ________________________ To: _______________________

List of Duties: _______________________________________________________________________

EMPLOYMENT DESIRED
Position: Team Leader Entry Level (Circle One) Date you can start: ____2 weeks_______ Full-time Evenings Temporary Weekends

Type of Employment Desired:

Part-time Day

EDUCATION

Name and Location of School

No. of Years Attended 3 years

Graduated? Yes / No Yes

Course Or Major Business

High School Trade School

Meadowdale High School Local 79 Mechanical Piping 5 years 1 year Yes No Yes Mechanical Piping Engineering Corrections Officer

College Other Education

Sinclair Community College 3 months Corrections Academy State of OH

EMPLOYMENT HISTORY
List your record of employment beginning with your present or most recent position.
Dates From To Name and Address of Employer Position Supervisors Name and Title Reason for Leaving

May 2012Current

Kindred Hospital 707 Edwin C. Moses Blvd Dayton OH

Security Officer

Tom Daphler

Currently employed

EMPLOYMENT HISTORY (continued)

Dates From To

Name and Address of Employer

Position

Supervisors Name and Title

Reason for Leaving

1999-2012

Lebanon Correctional Institute State Rt 63 PO Box 56 Lebanon OH

Corrections Officer

Captain M. Heard

Resigned looking for a better environment and change careers

Describe the work you did: Maintain security over the prison. Made sure inmates follow rules and regulations. Checked for contraband, conduct pat-down searches. Conducted daily security checks. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Dates From To Supervisors Name and Title Reason for Leaving

Name and Address of Employer

Position

1988-1999

Alloyd Insulation 5734 Webster Dayton OH

Mechanical Insulator

David Hines

Resign to become a corrections officer.

Describe the work you did: _Insulate mechanical systems, such as boilers, hot water lines, cold water lines and duct wrap.______________________________________________________________________________ ___ __________________________________________________________________________________ __________________________________________________________________________________ May we contact the employers listed above? one(s) you do not wish us to contact. Yes No If not, indicate which

______________________________________________________________________________ _________________________________________ Applicants Signature _____________________________ Date

DO NOT WRITE IN THE SPACE BELOW Interview by:__________________________________ Short listed: Yes ____No ____ P/B/DS: Date:_______________________________

Yes ____ No ____ Position_______________________

INSTRUCTIONS

Candidates for Team Leader that are short-listed will be contacted by our operations manager to arrange an interview. Entry Level applicants that are short-listed will be contacted by the team leader for their area to arrange an interview.

Complete the application truthfully, in full, and do not leave any blank spaces or unanswered questions. If you do not meet all the requirements, please wait until you do before applying. Include an up to date Resume. Write a brief statement explaining why you are interested in this position. Include copies of any training or certifications you have that are relevant to this profession. If the instructions are not followed, the application is incomplete or you do not meet the minimum requirements your application will not be processed. We require you to sign the application, you can scan your signed application and email it as an attachment to recruitment@suretysolutions.us , or you can Fax it to us at (206) 337-7509.

Thank you for your interest in the Surety Solutions, Fugitive Apprehension Specialist Team.