Employment Application

McGroarty & Bradburn Insurance Application for Employment

We are an equal opportunity employer, dedicated to a policy of non discrimination in employment on any basis including(but not limited to) age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability. Employment with McGroarty & Bradburn is at-will. Employment is entered into voluntarily, and employees are free to resign at any time. Similarly, McGroarty & Bradburn may terminate the employment relationship at any time, with or without notice or cause.

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

How were you referred to McGroarty & Bradburn Insurance, LLC?(Required)

Have you ever worked for or submitted an application with McGroarty & Bradburn Insurance, LLC before?(Required)

Yes

Please explain:

If you are under 18 years of age, can you provide required proof of work eligibility?(Required)

Yes

N/A

Are you eligible to work in the United States? (Proof of eligibility will be required upon employment)(Required)

Yes

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver's license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Are you currently licensed in Property & Casualty Insurance?(Required)

Yes

Please list the states that you are licensed in:

Has any state license you have held ever been suspended or revoked, or have any complaints or regulatory actions ever been filed against you or are you currently under investigation by any Department of Insurance?(Required)

Yes

Please explain the circumstances:

Have you ever been convicted or pled guilty or nolo contendere (no contest) or are you currently under investigation for any crime?(Required)

Yes

Please explain the circumstances:

Have you ever been convicted of a felony?(Required)

Yes

Please explain the circumstances:

Do you have any delinquent debts that cumulatively exceed $10,000 or have you filed for or been discharged from bankruptcy in the past 3 years?(Required)

Yes

Please explain the circumstances:

Are you bound by any agreement(s) (including signing a non-competition, non-disclosure, or non-piracy agreement) that would limit your ability to work for the agency?(Required)

Yes

Please explain:

Remote Work Questions(Required)

Hold the CTRL button and click on the choices that are true for you.

Education History

Do you have a High School Diploma?(Required)

Yes

Do you have a GED?

Yes

High School

Name of High School

Date of Graduation

Date GED was completed?

Do you have a College Degree or other Degree from Secondary Education?(Required)

Yes

College or Technical School

Name of School

Degree

Date of Graduation

Do you have any Designations or Certificates?(Required)

Yes

Please list your Designations or Certificates:

Hit the plus to add additional lines.

Employment Record

Did you submit a resume to us prior to completing this application?(Required)

Yes

Employment History

Employer

Dates

Position

Salary

Please list your last 3 jobs. Dates can be month & year.

References

Please do not include relatives.

References

Name

How do you know them?

Occupation

Phone Number

Please list at least 3 references.

Additional Information & Summary

Would you require health insurance through our health insurance plan?(Required)

Yes

We pay the full premium for eligible, full-time, salaried employees. Employees pay the additional cost for additional family members. If health insurance is not required, we will take this into consideration if a salary is offered.

If your application receives favorable consideration, what salary/hourly rate would you require?(Required)

Please provide any additional information or comments below.

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Application for Employment

McGroarty & Bradburn Insurance Application for Employment

Education History

Employment Record

References

Additional Information & Summary

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