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Employment Application

We are an Equal Opportunity Employer

Desired position information
Preferred Work Schedule *
Personal information
Are You Legally Eligible For Employment in this Country? *
Are you at Least 18 Years of Age? *
Criminal history
Have you been convicted of, plead guilty, no contest or nolo contendere to a crime within the past 7 years? *
Have you ever been charged with a crime and either placed on a court-ordered probation, had adjudication withheld, or entered a pre-trial intervention program? *
Education background
Diploma/Degree? *
Diploma/Degree? *
Employment history
May We Contact Them? *
Previous employment history
May We Contact Them?
Military service
Have you ever served in the United States Military? *
Are you currently serving in the Reserves or National Guard? *
Computer experience
Check any software you are familiar with
Are you familiar with any of the following agency management systems?
Do you have any experience with any of the following CRM Programs?
Insurance licensing and designations
Do you have any of the following licenses?
Do you have any of the following designations?
Employment application certification

I certify that the information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that if I am employed, any false statements or omissions will be considered cause for dismissal. Dumbaugh Insurance Agency, Inc is hereby authorized to conduct any verification of my personal, employment, education, credit and motor vehicle records, and to receive any information from the criminal justice agency in any state. I authorize listed previous employers and submitted references to give Dumbaugh Insurance Agency, Inc or its designated agent any and all facts, opinions and evaluations concerning my previous employment and any other information they may have, personal or otherwise. I release all such parties from any liability that may allegedly arise from furnishing such information to Dumbaugh Insurance Agency, Inc including, but not limited to, any liability for defamation or invasion of privacy.

If I am offered employment, I understand that such an offer will be conditioned upon satisfactory results of a background investigation. If my application is accepted for employment, I understand that the first ninety (90) days is an introductory period and I understand that my employment and compensation can be terminated, with or without cause or notice, at any time, regardless of the successful completion of my probationary period, at the option of either Dumbaugh Insurance Agency, Inc or myself. I understand that no leader or other representative of Dumbaugh Insurance Agency, Inc other than the president of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I certify that I have read, understand and agree with the above.

Required fields are marked with: *


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