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San Diego Insurance Staffing is an equal opportunity employer. We accept applicants and employ persons without regard to race, color, creed, national origin, sex, physical or mental handicap, or veteran's status. The information that you provide to us in this application will be used to evaluate your qualifications for the job. It will not be used for any discriminatory or illegal purposes.

* Denotes a Required Field

Personal Information

Are you at least 18 years of age and do you have the legal right to work in the United States? *

Yes

Have you ever been convicted of a felony? *
Answering YES will not automatically disqualify you for a position. However, it may hinder your ability to obtain positions that require licensing or bonding.

Yes


First Name *
Middle Initial
Last Name *
Nickname/Preferred Name
Address 1
Address 2
City
State
ZIP Code
Home Phone *		Area code and phone number
Other Phone		Area code and phone number
Email Address *

RESUME - Please copy & place your resume into the text box below.

Availability

Are you willing to work temporary?

Yes

Are you looking for a full-time career position?

Yes

Would you consider a temp-to-hire position?

Yes

When are you available to start?

(Enter a four digit year)

What weekday hours are you available?

What weekend hours are you available?

How many hours are you willing to work in a week?

Are you willing to work overtime?

Yes

What is the minimum pay you desire?

Hourly rate

How much notice will you need if a position is offered to you?

How many miles are you willing to travel to a position?

What field of insurance are you most qualified or wanting to work in? *

Education

Enter most recent - Do not enter start and end date if the most recent is high school

Name of School
Type of school
Street Address
City
State
ZIP Code
Start Date		(Enter a four digit year)
End Date		(Enter a four digit year)
Degree
Major Study Area
Other Studies

Employment History*

Please list your past three employers, starting with your most recent or current employer.

Current or Most
Recent Employer Name

City

State

ZIP Code

Supervisor Name

Phone Number

Your Job Title

Job Duties

Start Date

(Enter a four digit year)

End Date

(Enter a four digit year)

Start Wage

Hourly rate or annual salary

End Wage

Hourly rate or annual salary

May we contact this employer for a reference check?

Yes

Reason for Leaving

Previous Employer Name

City

State

ZIP Code

Supervisor Name

Phone Number

Your Job Title

Job Duties

Start Date

(Enter a four digit year)

End Date

(Enter a four digit year)

Start Wage

Hourly rate or annual salary

End Wage

Hourly rate or annual salary

May we contact this employer for a reference check?

Yes

Reason for Leaving

Previous Employer Name

City

State

ZIP Code

Supervisor Name

Phone Number

Your Job Title

Job Duties

Start Date

(Enter a four digit year)

End Date

(Enter a four digit year)

Start Wage

Hourly rate or annual salary

End Wage

Hourly rate or annual salary

May we contact this employer for a reference check?

Yes

Reason for Leaving

Territories: What areas would you commute to?

Licenses

Designations

Spanish

Sign Language

Tagalog

Bilingual - Other

Please read carefully, then initial at the bottom of this section.
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I understand that nothing contained in the application, or conveyed during the interview, which may be granted, or during my employment, if hired, is intended to create an employment contract between me and San Diego Insurance Staffing. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at anytime, with or without prior notice, at the option of either myself or San Diego Insurance Staffing, and that no promises or representations contrary to the foregoing are binding on San Diego Insurance Staffing unless made in writing and signed by me and the President of San Diego Insurance Staffing.

I understand that some clients of San Diego Insurance Staffing may administer drug testing of all employees including temporaries. By initialing below, I give permission for San Diego Insurance Staffing to place me with any of these clients. Thus, I also give permission to San Diego Insurance Staffing to release any and all test results to the clients which require this information for an assignment, regardless if temporary, temp-to-possible hire or direct hire opportunity.

Please take a moment to review your application. Indicate that you have read the above statement by entering your initials in the box below. To complete this application, click on the Submit Application button.

Initials: