Employment Application 1Contact Info2Previous Job Info3Final Questions PhoneThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formSourceFirst Name(Required)Last Name(Required)Mobile Phone(Required)Email(Required) Address(Required)City(Required)State(Required)StateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYDCZip Code(Required)Position Applying For(Required)Do you possess the following insurance licenses?(Required) Life Health Property Casualty Willing to get Licensed PREVIOUS EMPLOYMENTCompany NamePositionStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Tell us more about your current/previous experience and why you feel that would make you a good fit for this position: PLEASE EXPAND ON THE FOLLOWING QUESTIONS:Why are you interested in working at Breathe Insurance?(Required)What special skills or talents do you have that would help you be successful in this position?(Required)What do you think will be the greatest challenge for you in this position?(Required)What are some of your short-term and long-term goals?(Required)Final Thoughts(Required)Disclaimer and Signature Statement of Purpose I certify that my application and all attachments are true and complete to the best of my knowledge. I understand that any incorrect, incomplete, or false statements or information furnished by me may, at the discretion of Beacon Point Insurance disqualify me from employment, or cause my dismissal. I hereby authorize Beacon Point Insurance to make a thorough investigation of my past employment and activities. I release from liability Beacon Point Insurance, former employers, or any persons supplying such information. The language in this application is not intended to create, nor is it to be misconstrued to constitute, a contract of employment. I acknowledge that any employment relationship with Beacon Point Insurance is of an "at will" nature in which either party is free to terminate for any reason. It is further acknowledged that this "at will" employment relationship may not be changed by a written document or by conduct unless such a change is specifically acknowledged by the President of Beacon Point Insurance. I understand the misrepresentation or omission of facts may result in the rejection of this application, or if hired, corrective action up to and including dismissal. I understand that I may be required to sign a confidentiality or non-disclosure agreement should I become an employee of Beacon Point Insurance. I have read and understood the above agreement. this application is complete and accurate to the best of my knowledge.Consent(Required) I have read and understand the above agreement. this application is complete and accurate to the best of my knowledge.
