All form questions must be completed and submitted for review. ALL INFORMATION IS KEPT PRIVATE AND SECURE. The information is used to submit background checks for all agents applying to GreenGable Security LLC. All Additional files can be emailed or submitted through a separate link located below the form.
Greengable Security LLC
I certify that the information I have given in this application is true and completed to the best of my
knowledge and understand that falsification, omissions, or misrepresentations of this information is
grounds for rejection of my employment application and if employed by GreenGable Security, LLC or may
be terminated immediately. I authorize the character references, previous employers and education
institutions listed above to give you any information concerning my previous employment and any
pertinent information they may have, personal or otherwise, and all parties from all liability, claims, or
for any damage that may result from me. I also release GreenGable Security, LLC from any and all liability
of whatever kind and nature, which, at any time, could result from obtaining and having employment,
based on such information. I agree to conform to the rules and regulations of the company. Furthermore,
I understand that if an offer of employment is extended, it is conditioned upon completing the federal I-9
Form and providing documents establishing identity and work authorization. I understand that my
employment can be terminated with or without cause and with or without notice, at any time, at the
option of either the company or myself. I understand that only the owner, manager, or representative of
the company has the authority to enter into any agreement contrary to the foregoing.
I represent that I am able to meet the attendance requirements as required by the company. I
understand that by maintaining a current commission, license and operable mobile phone may be
necessary for continued employment. I have read and fully understood the applicant’s affirmation of
understanding and authorization (refer to page one of Employee Statement and Security Guard
Drug and Alcohol Testing Consent Form
I hereby agree, upon a request made under the drug/alcohol testing policy of Dynasty Security Services,
LLC, to submit to adrug or alcohol test and to furnish a sample of my urine, breath, and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under company policy, or if I otherwise fail to cooperate with the testing
procedures, I will be subject to immediate termination. I further authorize and give full permission to
have Dynasty Security Services, LLC and/or its company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the
laboratory or other testing facility to release any and all documentation relating to such test to the
Company and/or to any governmental entity involved in a legal proceeding or investigation connected
with the test. Finally, I authorize the Dynasty Security Services, LLC to disclose any documentation
relating to such test to any governmental entity involved in a legal proceeding or investigation
connected with the test. I also authorize Dynasty Security Services, LLC to field test my specimen. If
evidence is found, further testing may be required.
I understand that only duly-authorized Company officers, employees, and agents will have access to
information furnished or obtained in connection with the test; that they will maintain and protect the
confidentiality of such information to the greatest extent possible; and that they will share such
information only to the extent necessary to make employment decisions and to respond to inquiries or
notices from government entities.
I will hold harmless the Company, its company physician, and any testing laboratory the Company might
use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might
result from such testing, including loss of employment or any other kind of adverse job action that might
arise as a result of the drug or alcohol test, even if a Company or laboratory representative makes an
error in the administration or analysis of the test or the reporting of the results. I will further hold
harmless the Company, its company physician, and any testing laboratory the Company might use for any
alleged harm to me that might result from the release or use of information or documentation relating
to the drug or alcohol test, as long as the release or use of the information is within the scope of this
policy and the procedures as explained in the paragraph above.
This policy and authorization have been explained to me in a language I understand, and I have been
told that if I have any questions about the test or the policy, they will be answered.
I UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG SCREEN AND/OR ALCOHOL TEST UNDER
THIS POLICY WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER
CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN
THE ACCIDENT OR INJURY EVENT, AND I AGREE TO SUBMIT TO ANY SUCH TEST.