Al Thurmond Insurance Agency

Online Employment Application

Applicant 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.

Please note. This application is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements on this form are grounds for terminating the application process, or, if discovered after employment, terminating employment. Additional testing of job-related skills or for the presence of illegal drugs in your body may be required prior to employment.
Applicant Information
First Name *
Middle Initial
Last Name *
Address *
Apartment/Unit #
City *
State *
Zip Code *
Home Telephone
Daytime Telephone
Email Address
Position Information
Date Available to Begin work?
Which position are you interested in?
Comments
Desired Salary
Employment Verification
Are you authorized to work in the U.S? Yes  No
Are you at least 18 years of age?
If not, employment is subject to verification of minimum age.
Yes  No
Have you ever applied for work at Al Thurmond Agency? If yes, When? Yes  No
Can you perform all job-related functions (as described in job description)? Yes  No
Have you ever been convicted of, or been on probation or deferred adjudication for any felony or misdemeanor? If yes, please explain: Yes  No ?
Education Information
High School Name
City
ST
Receive High School Diploma? Yes  No
College/University
City
ST
How many years of College have you completed?
What is/was your course of study?
What was your graduation date/projected graduation date?
Please list all other Schooling:
Employment Experience
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
Address
City
ST
Zip Code
Phone
Job Title
Supervisor
Start Date
End Date
Starting Salary/Hourly Wage
Ending Salary/Hourly Wage
Reason for Leaving

Employer
Address
City
ST
Zip Code
Phone Number
Job Title
Supervisor
Start Date
End Date
Starting Salary/Hourly Wage
Ending Salary/Hourly Wage
Reason For Leaving

Employer
Address
City
ST
Zip Code
Phone Number
Job Title
Supervisor
Start Date
End Date
Starting Salary/Hourly Wage
Ending Salary/Hourly Wage
Reason for Leaving
References
Include only individuals familiar with your work ability. Do not include relatives. Please do not include individuals to whom you directly reported in the last five years.
  Name, Address, Phone: # Years Known Relationship
1.
2.
3.
Job Related Skills
Job Qualifications, including any special training, skills, licenses, and/or certificates.
Professional/business associations or designations relevant to the position you are applying for.
Referral Source
How did you hear about this position?
Please include the name of the person who referred you (if applicable)
Newspaper Ad  Employment Agency  Other
Disclaimer and submit
I certify that each my answers, and all information furnished on this application (and accompanying resume, if any) are true, complete and accurate and that I have not withheld or omitted any material information or response. I understand that false, misleading or incomplete information in my application, interviews or any other part of the pre-employment process may result in my immediate termination and/or the withdrawal of any employment offer. If employed, I agree to conform to all rules and regulations of Al Thurmond Agency. I understand that any employment at Al Thurmond Agency is "at-will" and is not for a fixed term or definite period. Either Al Thurmond Agency or I may terminate the employment relationship at any time, with or without cause or notice. I hereby authorize and consent to Al Thurmond Agency conducting a background, credit, employment, criminal, motor vehicle report or other investigative check, and release and hold harmless Al Thurmond Agency and any person or entity that provides information or records in connection with that investigation from any claim or liability.
Name
Date
* = Required Field
I hereby certify that I have a genuine interest in being hired and that all of the foregoing statements are true and correct. I agree to assume a continuing responsibility to disclose additional or new information, called for by this Employment Application, but known to me only after this Application was completed, and understand that my failure to make such a disclosure, and that falsification of any of the information given herein, on any employment form or in any interview, are grounds for immediate termination, regardless of when such failure or falsification may be discovered.

I also understand that my employment may be terminated at any time, with or without cause, without liability to me for salary, wages, or other benefits except as may have been earned up to date of the termination of services.

Al Thurmond Agency, Inc
(281) 679-8585

Click Here for Claim Numbers 

Al Thurmond Agency, Inc. is one of Houston's premier independent insurance agencies specializing in property & casualty insurance as well as employee benefits.

OUR MISSION is to provide unparalleled customer service to our valued clients while striving to offer the best coverage with a quality insurance carrier at a competitive cost. We realize that our clients depend on us and we welcome the challenge of handling their insurance needs.

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