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Applicant's Personal/Job Information
License Background Questions
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Eaglemind Insurance Agency is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.
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Please note: You must be able to pass a background Check in order to be appointed with the carriers we represent
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Last Name
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Positions and Openings
Which position(s) are you interested in?
How did you hear about this position?
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What days and times are you available for work?
On what date can you start working if you are hired?
Are you available to work during or around these hours? 9AM TO 5PM (M-F) AND/OR SAT: 10AM TO 2PM? You don't have to work all these hours but be available to answer phones, enroll clients or respond to client inquiries during peak hours within above hours.
Have you ever applied to or worked for Eaglemind Insurance Agency before?
If Yes, when?
Do you have any friends, relatives, or acquaintances working for Eaglemind Insurance Agency
If yes, state name and relationship
Are you 18 years of age or older?
Are you a U.S. citizen or approved to work in the United States?
What document can you provide as proof of citizenship or legal status?
Do you have any condition which would legally require job accommodations? If yes, please describe accommodations required below.
Have you ever been convicted of a criminal offense (felony or misdemeanor)?
If yes, please state the nature of the crime(s), when and where convicted and disposition of the case.
Job Skills/Qualifications: Please list below the skills and qualifications you possess for the position for which you are applying
Education and Training: Do you have a high school diploma or any degree? If so please list
Previous Employment: Name and address of Employer/Contractor
Previous Employment: Start Date
Previous Employment: End Date ( Leave Blank if still with this Employer/Contractor
Previous Employment: Job Title
Previous Employment: Supervisor Name
These are questions related to your license
Do you currently have an Active Insurance License?
If yes, what kind of Insurance License do you currently have?
If no, do you plan or desire to obtain your insurance license?
AT-WILL EMPLOYMENT: The relationship between you and the Eaglemind Insurance Agency is referred to as
By typing my name below, I certify the above statements to be true and correct to the best of my knowledge, and that this information can be used for the purpose of processing my job application and or to verify my identity or complete my background check.
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