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We invite you to complete this preliminary employment application. If you are invited to visit us for an in-person interview, you will be asked to complete a formal application.
Thank you.

Personal Information
Name
Address
City
State
Zip Code
Phone
E-mail
Are you over age 18? Yes   No
Are you in the country on a visa which would permit you to work here? Yes   No
Specify type
If you are not a citizen of the United States, do you have the legal right to work and reside in the United States? Yes   No

Education

High School
Years attended
School name
School location
Diploma? Yes   No

College
Years attended
School name
School location
Degree earned
Major subject

Licenses or Professional Designations

Languages (computer)

Clerical Skills
Typing speed
Word processing or spreadsheet software
Other software

Employment History
Position desired
Salary expected
Date available

Present or Most Recent Employer
Name of firm
Address
Title of position held
Date started
Date separated
Starting salary
Last salary
Name/title of supervisor
Reason for leaving

Previous employer
Name of firm
Address
Title of position held
Date started
Date separated
Starting salary
Last salary
Name/title of supervisor
Reason for leaving

Previous employer
Name of firm
Address
Title of position held
Date started
Date separated
Starting salary
Last salary
Name/title of supervisor
Reason for leaving

Federal and state laws prohibit discrimination because of race, national origin, religion, color, age, sex or non-job-related disability.

If you are offered a position with the company, you will be required to present credible documentation evidencing your identity and authorization for employment in the U.S. You will be expected to provide this documentation on commencement of work. In most instances, only original documents (not copies) are accepted, and you may be required to present more than one form of identification or authorization.

If employed by U.S. Financial Life Insurance Company, I agree to abide by its rules and regulations. Further, I understand that my employment with U.S. Financial Life is voluntarily entered into, and I am free to resign at any time. Similarly, U.S. Financial Life may terminate the employment relationship at any time, without notice, and for any reason not specifically prohibited by law.

I voluntarily give U.S. Financial Life the right to verify information contained in this application. I also consent to a pre-employment physical examination if requested, and I further understand that any false answer or statements made by me on this application, or any supplement thereto, will be grounds for immediate discharge.

 
I agree to the above: Yes   No
Date:

 
 
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