Employment Application Contact Information: First & Last Name:  * required Address:  * required  * required City, State, ZIP:  * required  * required  * required Day/Evening Phone: Fax: Email:  * required Date: Personal Information: Name (last, first, middle): Date of Birth: Do you have a current DPS license?: Yes No License # & Expiration Date: Home Address: Home or Business Phone: Can you prove your U.S. Citizenship?: Yes No If not a U.S. Citizen, give Visa No. and Expiration Date: Have you ever been convicted of a crime?: Yes No Position You Are Applying For: Title: Salary Requirement: Date You Can Start: Full Time/Part Time & are you willing to work Overtime? Education: High School (Name, City, State): Graduation Date: All Schools, Dates Attended and Degrees Earned: Last 3 Years of Employment: Employment References: In case of emergency, notify?: List your last two home addresses: Personal References (if applying for your first job, you may use an academic reference): “20+ years of around-the-clock protection” Arizona Protection Agency Office 480-423-0187   Employment 480-423-7772