Careers at Bowers Insurance

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Employment Application

THIS COMPANY IS AN EQUAL OPPORTUNITY EMPLOYER

Please Note: Complete all parts of the application. If your application is incomplete or does not clearly show the experience and/or training required, your application may not be accepted. If you have no information to enter in a section, please write N/A.

Position(s) applied for
Available start date
Employment Desired	Full Time	Part Time	Full or Part
Wage/Salary Desired

PERSONAL

Name
Address
Phone #
Other

List below present and past employment beginning with your most recent

Name/Address of Company
Position
From		To
Reason for Leaving
Starting Salary		Ending Salary
Supervisor
Describe the work performed, skills used or learned along with advancements/promotions while working at this job. (Place any additional comments in the comment box below.)

Name/Address of Company
Position
From		To
Reason for Leaving
Starting Salary		Ending Salary
Supervisor
Describe the work performed, skills used or learned along with advancements/promotions while working at this job. (Place any additional comments in the comment box below.)

Name/Address of Company
Position
From		To
Reason for Leaving
Starting Salary		Ending Salary
Supervisor
Describe the work performed, skills used or learned along with advancements/promotions while working at this job. (Place any additional comments in the comment box below.)

Only US Citizens or aliens who have a legal right to work in the US are eligible for employment. Can you, upon employment, submit documentation of your identity and your legal right to work in the US

yes

no

Have you ever been a defendant in a civil action for an intentional tort	yes No
If YES, please state the circumstances, including a description of the nature of the intentional tort, the date that it was allegedly committed and the disposition of the action

Have you ever been convicted of a crime, had adjudication withheld, or pled no contest to a crime	yes No
If YES, please state the type of crime and the circumstances with regard to each, including date of the conviction or plea and the penalty, if any, imposed by the court

NOTE: Answering YES to any of these questions may not necessarily disqualify you from the position you desire. Each action and explanation will be weighted/considered in relationship to the position for which you are applying.

EDUCATION

High School:
Name & Address
Last Year Completed
College:
Name & Address
Major
Degree
Last Year Completed
Other:
Name & Address
Major
Degree
Last Year Completed

Additional Comments:

I attest to the truthfulness of any and all information and answers provided above. Any false or misleading statements will be grounds for denial of employment or discharge. I understand that the company will be checking into my references and employment background. I authorize the Company to do so and release from liability anyone giving or obtaining such background information. This application does not constitute a contract of employment or an indication that any jobs are available. Any employment with the Company is at-will, meaning the employer or employee can end the employment relationship at any time for any or no reason and with or without notice. My signature below verifies that I have read and understand the foregoing statements.


Signature

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