EMPLOYMENT APPLICATION

All information entered on this form is considered to be offered as a sworn statement. Any misstatement of fact is reason for disqualification for employment, or may be punishable by law as per N.J.S. 2C:28-2, 2C:28-3 and 2C:28-7.

No person shall be employed by any holder of security agency license until such person to be employed shall have executed and furnished to such license holder the following statement, pursuant to the provisions of “The Security Officer Registration Act (SORA)” as amended by Chapter 134, Laws of 2004.

Name of Security Agency:  ROMAN SECURITY AGENCY, LLC

Address:  561 BLOOMFIELD AVENUE, 2ND FLOOR, NEWARK, NJ 07107

 Date License Issued:  AUGUST 28, 2007

 Number of License:  1026