Western Marketing - Application for Employment

	senior insurance products

Medicare Med Supp Rate Comparisons Med Supp Marketing Kits Med Advantage Marketing Kits Annuities Annuity Search Forms Search Carrier Profiles MYG Rate Guide Annuity Sales Guide Annuity Marketing Kits Life Term Life Quotes Forms Search Carrier Profiles Life Marketing Kits Final Expense Final Expense Marketing Kits LTC Long-Term Care Marketing Kits Short-Term Care Marketing Kits Other Dental Hospital Indemnity Major Medical

Application for Employment

E-mail Address: *
Position(s) Applied For: *
Name: *
Address: *
Telephone Number: *
Best time to contact you at home is: *
Are you currently employed?	Yes No
If so, may we contact your present employer?	Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?	Yes No
Date available for work:
What is your desired salary range?
Are you available to work:	Full-Time Part-Time Temporary
Are you currently on lay-off status and subject to recall?	Yes No
Can you travel if a job requires it?	Yes No
List the name of your high school and the number of years completed:
List the name of any undergraduate colleges you attended, the number of years completed, and type of diploma/degree earned:
List any other education you may have received:
Describe any specialized training, apprenticeship, skills and extra-curricular activities:
Describe any job-related training received in the United States military:
Your last employers name, address and phone number:
Your job title at your last job:
Your supervisors name at your last job:
Reason for leaving your last job:
Dates employed at your last job:
Work performed at your last job:
Starting and Final Hourly Rate/Salary at your last job:
Other employer: (Give name, address, phone number)
Your job title at this job:
Reason for leaving this job:
Work performed at this job:
Summarize special job-related skills and qualifications acquired from employment or other experience:
Specialized Skills: (Check all that apply)	PC Excel Spreadsheet Word Processing Telemarketing ACT! Database Other
State any additional information you feel may be helpful to us in considering your application:
Reference #1: (name, address and phone #)
Reference #2:
Reference #3:


* Required