Career Opportunities - Caple Howden Insurance Agency, Inc.

Applicant Information
- First Name*
- Middle Initial
- Last Name*
- Suffix
- Email Address*
- Address*
  Street Address City State / Province / Region ZIP / Postal Code Country
- Home Telephone
- Daytime Telephone
Position Information
- Which position are you interested in?
- Comments
- Desired Salary
- Willing to relocate?
  - Yes
  - No
- Full-Time 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?
- Are you at least 18 years of age?
  - Yes
  - No
Citizenship Information
- Are you prevented from being lawfully employed in this country due to a Visa or immigration status?
  - Yes
  - No
Education Information
- High School Name
- City
- ST
- Receive High School Diploma?
  - Yes
  - No
- College/University
- City
- ST
- How many years of College have you completed?
- What is/was your course of study?
- What was your graduation date/projected graduation date?
- Please list all other Schooling:
Job Related Skills
- List any languages other than English that you speak fluently:
- Mark all skills that apply:
  - Word Processing
  - 10 Key adding Machine
  - Typing
- Number of Words Per Minute:
- List all knowledge of computer programs:
- List any other skills:
- List any licenses or certifications you have that you feel would be of value to this job or company:
Security
- Have you ever been bonded in prior employment?
  - Yes
  - No
- Have you ever been convicted of a misdemeanor or a felony?
  - Yes
  - No
- If Yes, please explain:
Background Authorization
- If I am interviewed and accept employment, I agree to allow company to investigate my background.
  - Yes
  - No
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.
- Employer
- Address
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Phone
- Job Title
- Supervisor
- Start Date
- End Date
- Starting Salary/Hourly Wage
- Ending Salary/Hourly Wage
- Reason for Leaving
- Empoyer
- Address
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Phone Number
- Job Title
- Supervisor
- Start Date
- End Date
- Starting Salary/Hourly Wage
- Ending Salary/Hourly Wage
- Reason for Leaving
- Employer
- Address
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Phone Number
- Job Title
- Supervisor
- Start Date
- End Date
- Starting Salary/Hourly Wage
- Ending Salary/Hourly Wage
- 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.
- Name, Address, Phone: 1.
- # Years Known
- Relationship
- Name, Address, Phone: 2.
- # Years Known
- Relationship
- Name, Address, Phone: 3.
- # Years Known
- Relationship
* = Required Field 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.