APPLICANT INFORMATION

Full Name

Address

City, State, Zip

Home Phone

Daytime Phone

Email Address

Are you prevented from being lawfully employed in this country due to a Visa or immigration status?

Are you at least 18 years of age?

POSITION INFORMATION

Which position?

Comments

Desired Salary

Willing to relocate?

Full or part-time employment?

Full-time
Part-time

If part-time, how many hours per week are you available?

What date are you available to start?

EDUCATION INFORMATION

High School

High School City, State

High School Diploma?

College/University

College/University City, State

How many years of college have you completed?

What is/was your course of study?

Graduation date/Projected graduation date

Please list all other schooling

JOB-RELATED SKILLS

Fluent languages?

Skills

Word Processing
10 Key Adding Machine
Typing

Typing WPM

Computer programs you're proficient in?

List any other related skills

Related licenses or certifications

SECURITY

Have you ever been bonded in previous employment?

Have you ever been convicted of a misdemeanor or a felony?

If Yes, please explain

Have you ever filed for bankruptcy?

Allow background investigation?

EMPLOYMENT EXPERIENCE

Please go back 5 years, listing your most recent employer first. Include any gaps in employment and state the reason for no employment during that period.

Most Recent Employer

Address

City, State, Zip

Phone

Supervisor

Start Date - End Date

Start Salary - End Salary

Reason for Leaving

Second Most Recent Employer

Address

City, State, Zip

Phone

Supervisor

Start Date - End Date

Start Salary - End Salary

Reason for Leaving

Third Most Recent Employer

Address

City, State, Zip

Phone

Supervisor

Start Date - End Date

Start Salary - End Salary

Reason for Leaving

REFERENCES

Include only individuals familiar with your work ability. Do not include relatives. Please do not include individuals to whom you directly reported in the last five years.

#1: Name, Address, Phone

Years Known

Relationship

#2: Name, Address, Phone

Years Known

Relationship

#3: Name, Address, Phone

Years Known

Relationship

Lets see if you're human

DISCLAIMER

I agree to the following:

I hereby certify that I have a genuine interest in being hired and that all of the foregoing statements are true and correct. I agree to assume a continuing responsibility to disclose additional or new information, called for by this Employment Application, but known to me only after this Application was completed, and understand that my failure to make such a disclosure, and that falsification of any of the information given herein, on any employment form or in any interview, are grounds for immediate termination, regardless of when such failure or falsification may be discovered.

I also understand that my employment may be terminated at any time, with or without cause, without liability to me for salary, wages, or other benefits except as may have been earned up to date of the termination of services.

Join Our Team

We are always looking to expand our team with motivated and energetic individuals. We currently have eight locations throughout the state, including Alpena, Gaylord, Petoskey, and Traverse City. Don't see your next career listed, complete this form so that we can set up a time to meet and learn more about exciting opportunities in insurance.

Please note. This application is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements on this form are grounds for terminating the application process, or, if discovered after employment, terminating employment. Additional testing of job-related skills or for the presence of illegal drugs in your body may be required prior to employment.

Required fields are marked with ✶

Our Locations

Alpena
514 N Ripley Blvd
Alpena, MI 49707

Local: (989) 356-6133

Hillman
150 State St
Hillman, MI 49746

Local: (989) 742-4574

Traverse City
3183 Logan Valley Rd
Traverse City, MI 49684

Local: (231) 947-1164

Iron River
117 W Genesee St, Ste 1
Iron River, MI 49935

Local: (906) 265-5137

Petoskey
1170 Bay View Rd, Ste B
Petoskey, MI 49770

Local: (231) 347-4610

Gaylord
440 W Main St, Ste F
Gaylord, MI 49735-1401

Local: (989) 705-8664