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Employment at Team Insurance
Employment Application
Use the form below to inquire about employment opportunities with our company. Upon submission, it will be reviewed and you will be contacted for more information if needed. Thanks for your interest in our company!
Personal
Full Name (First + Middle + Last)
*
Permanent Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Cell Phone
*
Email
*
Do you have the legal right to live and work in the U.S.?
*
Yes
No
Other name(s) under which you have been previously employed
Names of friends or relatives employed in this organization (optional)
Have you ever applied to this organization before?
*
Yes
No
If Yes, give date and position applied for
Have you ever been convicted of a felony?
*
Yes
No
Will you comply with the safety work and attendance policies of our organization?
*
Yes
No
Employment Interests
Position(s) Desired or Area of Interest:
*
CSR (Customer Service Representative)
Insurance Producer
Date Available
*
MM slash DD slash YYYY
Type of Employment You Are Seeking:
*
Full Time
Part Time
Desired Hourly/Weekly/Monthly Pay
*
How were you referred to our organization?
*
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Employee
Other Company
Agency
Self
Name of Referral Source:
Education/U.S. Military Service
Where did you attend high school &/or College? (Click the + button to add a new row)
School Name
Year Started
Year Completed
References
List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)
Name
Contact Number
Occupation
Years Known
Employment History
Give employment record as completely as possible listing current or most recent employer first.
Places of Employment
Name of Company
Contact Number
Occupation
Date Started
End Date
Reason for Leaving Last Place of Employment:
May we contact previous employers?
Yes
No
Potential Employement Information
Desired Base Rate of Pay (Hour/Week/Month)
Start
End
I agree to a Drug Screening at the company's expense.
*
Yes
No
I agree to a Criminal Background Check at the company's expense.
*
Yes
No
Acknowledgement
By submitting this application I am aware that this is not an offer of employment, and that by submitting this information I give permission for prospective employer to do due diligence regarding my potential employment using the information container herein.
Digital Signature:
Printing your First Name + Middle Initial + Last Name will act as your digital signature.
Date
MM slash DD slash YYYY
Resume Upload (optional)
Accepted file types: doc, docx, pages, odt, rtf, tex, txt, wpd, wps, pdf, Max. file size: 50 MB.
If you have a resume you'd like to attach, please do so here. This is not required.
Would you like to add a cover letter?
Yes
No
Cover Letter (optional)
Max. file size: 50 MB.
Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.
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