Urbanke Insurance is always looking for energetic individuals to join our team. We have positions open in account management, customer service, and sales. We are a full service independant insurance agency that handles all lines of personal, business, life insurance and financial products. Please feel free to print off and complete the application below to be considered for a position. You can email it to steve@urbankeinsurance.com, mail it to our Frankfort office, or fax it to (315) 894-3488. You can also email your resume to the email address above.
PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE |
|
|
| APPLICATION FOR EMPLOYMENT |
| APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS |
| |
| PLEASE COMPLETE PAGES 1-3. |
DATE ___________________________________ |
| Name ___________________________________________________________________________________________________ |
| Last First Middle Maiden |
| Present address __________________________________________________________________________________________ |
| Number Street City State Zip |
| How long ______________________ |
Social Security No. _______ – _____ – _________ |
| Telephone ( ) |
| If under 18, please list age _______________________ |
Position applied for (1)__________________________ 3) Is hospitalization a necessity in the immediate future?_____and salary desired (2) _________________________ (Be specific) |
|
| Employment desired qFULL-TIME ONLY qPART-TIME ONLY qFULL- OR PART-TIME |
| When available for work?______________________________________________________ |
| Can we check with your present employer?_________________________ |
| |
| TYPE OF SCHOOL |
NAME OF SCHOOL |
LOCATION
(Complete mailing address) |
NUMBER OF YEARS COMPLETED |
MAJOR & DEGREE |
| High School |
|
|
|
|
| |
|
|
|
|
| College |
|
|
|
|
| |
|
|
|
|
| Bus. or Trade School |
|
|
|
|
| |
|
|
|
|
| Graduate or Professional School |
|
|
|
|
| |
|
|
|
|
| |
| HAVE YOU EVER BEEN CONVICTED OF A CRIME? q No q Yes |
| If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation. ______________________________________________________ |
| ________________________________________________________________________________________________________ |
| |
|
|
|
|
|
|
|
|
|
| APPLICATION FOR EMPLOYMENT |
| |
Page 2 |
|
PREVIOUS EMPLOYERS: List your last four employers starting with present or most recent.
| Dates of employmentMonth & year |
Name and AddressOf Employer |
Salary per hour |
Position |
Reason for Leaving |
| From |
|
|
|
|
| To |
|
|
|
|
| From |
|
|
|
|
| To |
|
|
|
|
| From |
|
|
|
|
| To |
|
|
|
|
| From |
|
|
|
|
| To |
|
|
|
|
| |
|
|
|
|
|
|
|
Insurance Experience q Yes q No - IF YES, CHECK ONE q Agency q Company
Sales Experience q Yes q No Customer Service Experience q Yes q No
|
| Personal q Yes PC q Computer q No Mac q |
Other __________________________________________ Skills __________________________________________ |
| |
| Please list two business and/or personal references other than relatives or previous employers. |
| Name _____________________________________ |
Name __________________________________________ |
| Position ___________________________________ |
Position ________________________________________ |
| Company __________________________________ |
Company _______________________________________ |
| Address ___________________________________ |
Address ________________________________________ |
| ___________________________________ |
________________________________________ |
| Telephone ( ) |
Telephone ( ) |
| An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying. Feel free to send a resume as well. |
| |
| |
| OFFICE USE ONLY |
RANK 0 – 10 ___________ |
2ND INTERVIEW DATE |
/ / @ |
|
|
| |
|
|
|
|
PLEASE READ CAREFULLY
|
|
APPLICATION FORM WAIVER
|
| In exchange for the consideration of my job application by ___________________ (hereinafter called “the Company”), I agree that:Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of , or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. |
| I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. |
| I also understand that (1) the Company has a drug and alcohol policy that provides for preemployment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations. |
| I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. |
| I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party. |
| Signature of applicant__________________________________________ Date: ___________________ |
| This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications. |
| Thank you for completing this application form and for your interest in our business.
|
|