Employment Application

  • Date Format: MM slash DD slash YYYY
  • Personal Information
  • Employment (Start with most recent employment and work backwards)
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Education
  • School NameSchool AddressGrade Completed / DegreeSubjects Studied 
  • Licenses List state & license # of any licenses you have below:
  • Software

  • Microsoft Word
  • Microsoft Excel
  • Microsoft PowerPoint
  • Microsoft Outlook
  • APPLIED
  • AMS
  • NameCompany NameAddressPhoneOccupationRelationship 
  • Additional Experience or Qualifications
  • Notification and Agreement (Please read before submitting)

    It is Insurance One Agency’s policy to afford equal opportunity to all employees and applicants for employment without regard to age, race, religion, color, sex, national origin, marital status or sexual orientation, individuals with a disability, or any other characteristic protected by applicable Federal, State or Local law.

    I authorize the investigation of all statements and information contained in this application. I release from liability anyone supplying such information and I also release Insurance One Agency from all liability that might result from making an investigation

    If employed, I agree to not engage in any outside activity that would involve a material conflict of interest with, or could reflect adversely on Insurance One Agency. I understand that Insurance One Agency retains the right to solely decide when such conflict exists.

    If employed, I agree to hold in strictest confidence any information concerning Insurance One Agency, its Insureds, and its Carriers that may come to my knowledge.

    In consideration of my employment, if I am employed, I agree to conform to the employment policies of Insurance One Agency, and understand that my employment and compensation can be terminated, with or without notice, at any time, at the option of either Insurance One Agency or myself. I understand that no representative of Insurance One Agency, other than the President, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.

    I understand that completion of this employment application does not guarantee that I have been employed by Insurance One Agency.

    I certify that all answers given by me are true, accurate and complete, I understand that the falsification, misrepresentation or omission of fact on this application (or any other accompanying or required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.