Employment Application Application for Employment Application for Employment Step 1 of 3 33% McGroarty & Bradburn Insurance Application for EmploymentWe are an equal opportunity employer, dedicated to a policy of non discrimination in employment on any basis including(but not limited to) age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability. Employment with McGroarty & Bradburn is at-will. Employment is entered into voluntarily, and employees are free to resign at any time. Similarly, McGroarty & Bradburn may terminate the employment relationship at any time, with or without notice or cause. Name(Required) First Middle Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) How were you referred to McGroarty & Bradburn Insurance, LLC?(Required) Have you ever worked for or submitted an application with McGroarty & Bradburn Insurance, LLC before?(Required) Yes No Please explain: If you are under 18 years of age, can you provide required proof of work eligibility?(Required) Yes No N/A Are you eligible to work in the United States? (Proof of eligibility will be required upon employment)(Required) Yes No Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver's license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.Are you currently licensed in Property & Casualty Insurance?(Required) Yes No Please list the states that you are licensed in: Has any state license you have held ever been suspended or revoked, or have any complaints or regulatory actions ever been filed against you or are you currently under investigation by any Department of Insurance?(Required) Yes No Please explain the circumstances: Have you ever been convicted or pled guilty or nolo contendere (no contest) or are you currently under investigation for any crime?(Required) Yes No Please explain the circumstances: Have you ever been convicted of a felony?(Required) Yes No Please explain the circumstances: Do you have any delinquent debts that cumulatively exceed $10,000 or have you filed for or been discharged from bankruptcy in the past 3 years?(Required) Yes No Please explain the circumstances: Are you bound by any agreement(s) (including signing a non-competition, non-disclosure, or non-piracy agreement) that would limit your ability to work for the agency?(Required) Yes No Please explain: Remote Work Questions(Required)I want to work remotely.I have worked remotely in the past.I have an office or work area to help prevent distractions during work hours.I have high speed internet access.None of the AboveHold the CTRL button and click on the choices that are true for you. Education HistoryDo you have a High School Diploma?(Required) Yes No Do you have a GED? Yes No High SchoolName of High SchoolDate of Graduation Add RemoveDate GED was completed? Do you have a College Degree or other Degree from Secondary Education?(Required) Yes No College or Technical SchoolName of SchoolDegreeDate of Graduation Add RemoveDo you have any Designations or Certificates?(Required) Yes No Please list your Designations or Certificates: Add RemoveHit the plus to add additional lines.Employment RecordDid you submit a resume to us prior to completing this application?(Required) Yes No Employment HistoryEmployerDatesPositionSalary Add RemovePlease list your last 3 jobs. Dates can be month & year.ReferencesPlease do not include relatives.ReferencesNameHow do you know them?OccupationPhone Number Add RemovePlease list at least 3 references. Additional Information & SummaryWe are an equal opportunity employer, dedicated to a policy of non discrimination in employment on any basis including(but not limited to) age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability. Employment with McGroarty & Bradburn is at-will. Employment is entered into voluntarily, and employees are free to resign at any time. Similarly, McGroarty & Bradburn may terminate the employment relationship at any time, with or without notice or cause. Would you require health insurance through our health insurance plan?(Required) Yes No We pay the full premium for eligible, full-time, salaried employees. Employees pay the additional cost for additional family members. If health insurance is not required, we will take this into consideration if a salary is offered.If your application receives favorable consideration, what salary/hourly rate would you require?(Required) Please provide any additional information or comments below.