Aegis Insurance Employment Applicatio

Aegis Insurance Employment Application.
Form 1a.
Please complete all form fields

Position desired

Personal Information.

Name (Last, First, Middle Initial)
Address
City	State		Zip
Birth Date		(mm/dd/yy)	Sex	MaleFemale
		Social Security Number
Home Phone Number		Mobile Number
Email Address			Web Address	(myspace.com, etc)

Education

School
Address
City		State	Zip
Diploma	YesNo
Major		Graduation Year

School
Address
City		State	Zip
Diploma	YesNo
Major		Graduation Year

(need help looking up information use Superpages.com)

Work Experience.
please list 3 most recent employers.

Employer
Address		Length of time employed
City	State		Zip
Position	Title
Responsibilities		Employment Dates	(mm/dd/yy)

Employer
Address		Length of time employed
City	State		Zip
Position	Title
Responsibilities		Employment Dates	(mm/dd/yy)

Employer
Address		Length of time employed
City	State		Zip
Position	Title
Responsibilities		Employment Dates	(mm/dd/yy)

Criminal Record

Have you been convicted of a crime?	YesNo
If yes please explain.
Have you been charged with or been released/removed from a position due to any misappropriation of money or dishonest act? (list all incidents)

Skills.
please list any special skills you may have relating to Insurance, Sales, Telemarketing or Office experience

Additional information about yourself.

This is a preliminary application. anyone completing this application should understand this information is preliminary only and may be used to select candidates to interview. If this application results in you having an interview you will be required complete a paper application. by submitting this application you are stating that the information listed above is true and factual. should any information be untruthful it may result in your application being rejected and will not be considered for employment.


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