CONTACT US TODAY: 1-866-276-9622 OR EMAIL US: [email protected] We are available to help you with your insurance needs. Application for Employment at Trustpoint InsuranceEqual Employment Opportunity Statement: Employment decisions will be based on the principles of equal opportunity. All personnel actions (recruiting, hiring, training, promotion, compensation, etc.) are administered without regard to any characteristic protected by state, federal or local law, assuming said characteristic does not interfere with the performance of essential job functions. Reasonable accommodations will be made for disabilities and religious beliefs. Please inform us of any necessary accommodations to the application process.Applicant Name and Contact InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Have you ever gone by a name(s) other than the one listed above?* Yes No List name(s)* General Information / ExpectationsHow did you learn about Trustpoint?*AdvertisementEmployee ReferralEmployment AgencyOtherSpecify* What advertisement, which employee, which recruiter or describe other.Have you ever applied or been employed with us before?* Yes - Applied Yes - Employed No Are you currently employed?* Yes No When did previous employment end?* MM slash DD slash YYYY What was your previous position?* When was your previous application made?* MM slash DD slash YYYY When are you available to start work?* MM slash DD slash YYYY Available Status*Full TImePart TimeSeasonalCan you travel for work if necessary?* Yes No Are you over 18 years of age?* Yes No Are you legally permitted to work in the United States?* Yes No NOTE: Proof off eligibility will be required at the time of employment.Are you willing to take a company drug test?* Yes No EducationWhat is the highest level of education completed?*High School DiplomaSome CollegeCollege DegreeGraduate DegreeNone of the AboveName of High School* Location of High School* High School GPA* Name of College* Location of College* College GPA* What was your degree/major?* How many years did you attend college?Name of Graduate School* Location of Graduate School* Graduate School GPA* What was your graduate degree/major?* Describe your education background.* Do you have any insurance licenses?* Yes No What insurance licenses do you have?* Property and Casualty Life and Health Claims Adjuster Surplus Lines Other Check all that apply.Do you have any insurance designations?* Yes No Such as CPCU, CIC, CISR, ACSR etc.Specify designations* Any other training, licenses or designations you would like us to know about? Employment HistoryHow many former employers do you have?*Please enter a number greater than or equal to 1.If you have more than 4 please upload a separate list.1. Current Employer Name* 1. Current Supervisor Name* 1. Current Employer Address* 1. Current Employer Phone* 1. Current Position Title and Duties* 1. Most Recent Employer Name* 1. Most Recent Supervisor Name* 1. Most Recent Employer Address* 1. Most Recent Employer Phone* 1. Most Recent Position Title and Duties* 1. Start Date* MM slash DD slash YYYY 1. End Date* MM slash DD slash YYYY 1. Starting Pay1. Ending Pay1. Why did you leave this job?* 1. May we contact this employer?* Yes - Now Yes - Later No 2. Previous Employer Name* 2. Previous Supervisor Name* 2. Previous Employer Address* 2. Previous Employer Phone* 2. Previous Position Title and Duties* 2. Start Date* MM slash DD slash YYYY 2. End Date* MM slash DD slash YYYY 2. Starting Pay2. Ending Pay2. Why did you leave this job?* 2. May we contact this employer?* Yes No 3. Previous Employer Name* 3. Previous Supervisor Name* 3. Previous Employer Address* 3. Previous Employer Phone* 3. Previous Position Title and Duties* 3. Start Date* MM slash DD slash YYYY 3. End Date* MM slash DD slash YYYY 3. Starting Pay3. Why did you leave this job?* 3. May we contact this employer?* Yes No 4. Previous Employer Name* 4. Previous Supervisor Name* 4. Previous Position Title and Duties* 4. Previous Employer Address* 4. Previous Employer Phone* 4. Start Date* MM slash DD slash YYYY 4. End Date* MM slash DD slash YYYY 4. Ending Pay4. Starting Pay4. Ending Pay4. Why did you leave this job?* 4. May we contact this employer?* Yes No Personal References1. Reference Name* 1. Reference Phone*1. Years Known*Please enter a number greater than or equal to 1.2. Reference Name* 2. Reference Phone*2. Years Known*Please enter a number greater than or equal to 1.3. Reference Name* 3. Reference Phone*3. Years Known*Please enter a number greater than or equal to 1.Upload DocumentsYou indicated more than 4 previous employers. Please upload a list of those employers with Name, Supervisor Name, Phone Number, Date Started, Date Ended, Starting Salary, Ending Salary, Reason Left and if we can contact them.Upload DocumentsIf you have any documents that you would like to attach as part of your application (such as a resume) you may do so here. Drop files here or Select files Max. file size: 64 MB. Applicant's StatementUpon submitting this electronic application: I certify that the information provided in this application is true, to the best of my knowledge. I understand that providing false or misleading information at any time during the application and interview process may lead to refusal to hire or discharge from the Company. If I become employed by Trustpoint Insurance, I agree to follow all rules and regulations of the Company as they develop and change. I allow the Company to conduct investigations on me, my background and my performance, and am aware that such investigations will become a part of my employment record. With this, I authorize the Company to speak with my acquaintances, personal and professional, to gather information about me. I authorize all former employers and references to provide any information about me to the Company, and release them of liabilities and damages of all kinds for providing this information. I authorize the Company to verify the accuracy of the information within this application. I also authorize the release of my educational transcripts to the Company for education verification purposes. I release from liability for collecting information about me and using it to make employment decisions. If I become employed by the Company, I understand that the employment relationship will be “at will,” and that the “at will” status may not change at any time unless specifically approved, in writing, by the President of the Company. I agree that if I become indebted to the Company, I will be responsible for repaying the total owed upon termination from the Company. If I do not repay the sum prior to my final paycheck being received, the money owed will be deducted from my pay. This application for employment is valid for the next 90 days. I understand that if I wish to be considered for employment after this period of time, I must apply again.