Halcyon Underwriters

1 of 8

Applicant Information

Instructions:
Incomplete applications will not be processed. This application will be considered active for 180 days. Any applicant wishing to be considered beyond this time period should submit another application.

Full Name

Address

Home Telephone

Daytime Telephone

Email Address

Are you at least 18 years of age?

Yes No

Are you prevented from being lawfully employed in this country due to a Visa or immigration status?

Yes No

2 of 8

Position Information

Which position are you interested in?

Comments

Desired Salary

Willing to relocate?

Yes No

Full-Time or Part-Time employment?

Full-Time Part-Time

How many hours per week are you available?

What date are you available to start?

3 of 8

Education

High School Name

High School City, State

Receive High School Diploma?

Yes No

College/University

College/University City, State

What is/was your course of study?

How many years of College have you completed?

What was your graduation date/projected graduation date?

Please list all other Schooling:

4 of 8

Job Skills

List any languages other than English that you speak fluently:

Word Processing

Yes No

10 Key Adding Machine

Yes No

Typing / Keyboard

Yes No

Words Per Minute

List all knowledge of computer programs:

List any other skills:

List any licenses or certifications you have that you feel would be of value to this job or company

5 of 8

Security & Background

Have you ever been bonded in prior employment?

Yes No

Have you ever been convicted of a misdemeanor or a felony?

Yes No

If Yes, please explain

If I am interviewed and accept employment, I agree to allow company to investigate my background.

Yes No

6 of 8

Prior Employement

Please go back 5 years, listing your most recent employer first. Include any gaps in employment and state the reason for no employment during that period.

Employer Name

Address

Phone

Job Title

Supervisor

Employment Dates

Salary / Hourly Wages

Reason for Leaving

Employer Name

Address

Phone

Job Title

Supervisor

Employment Dates

Salary / Hourly Wages

Reason for Leaving

Employer Name

Address

Phone

Job Title

Supervisor

Employment Dates

Salary / Hourly Wages

Reason for Leaving

Employer Name

Address

Phone

Job Title

Supervisor

Employment Dates

Salary / Hourly Wages

Reason for Leaving

Employer Name

Address

Phone

Job Title

Supervisor

Employment Dates

Salary / Hourly Wages

Reason for Leaving

7 of 8

References

8 of 8

Confirm

Include your Cover Letter and Resume.
Document types: Word or PDF

1 of 8

Applicant Information

2 of 8

Position Information

3 of 8

Education

4 of 8

Job Skills

5 of 8

Security & Background

6 of 8

Prior Employement

7 of 8

References

8 of 8

Confirm

Complete