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Apply to Stumm Insurance
Step
1
of
6
16%
Name
(Required)
First
Last
Date
(Required)
MM slash DD slash YYYY
Address
(Required)
Street Address
Address Line 2
City
State
ZIP / Postal Code
Phone
(Required)
Are you 18 years of age or older?
(Required)
Yes
No
Are you either a U.S. citizen or an alien authorized to work in the U.S.?
(Required)
Yes
No
Have you ever worked or attended school under another name? If so, under what name?
(Required)
Position Desired
Position
(Required)
Start date available
(Required)
MM slash DD slash YYYY
Wage rate desired ($)
(Required)
Pay frequency
(Required)
Hourly
Monthly
Annually
Do you prefer
(Required)
Full-time
Part-time
If part-time, hours per week desired
Hours you are available to work
(Required)
Days of week you are available to work
(Required)
Are you available to work
Weekends
Holidays
Nights
Overtime
Have you previously worked for Stumm Insurance, LLC.?
(Required)
Yes
No
Dates of employment with Stumm Insurance, LLC, from:
(Required)
MM slash DD slash YYYY
to:
(Required)
MM slash DD slash YYYY
Reason(s) for leaving
(Required)
Former supervisor(s) at Stumm Insurance, LLC.:
(Required)
How did you learn about this opening?
(Required)
Education
High School:
(Required)
Graduated?
(Required)
Yes
No
Course of Study:
Technical School:
Graduated?
Yes
No
Course of Study:
College/University:
Graduated?
Yes
No
Course of Study:
Post-Graduate Education:
Graduated?
Yes
No
Course of Study:
Other education, training or special skills:
Certifications (list certifications)
Certifications
Add
Remove
Work Experience
Please list all previous employment, beginning with the most recent.
Upload Resume/CV
(Required)
Max. file size: 50 MB.
Employer #1:
(Required)
Employer Address:
(Required)
Street Address
Address Line 2
City
State
ZIP / Postal Code
From:
(Required)
MM slash DD slash YYYY
To:
(Required)
MM slash DD slash YYYY
Position Held:
(Required)
Reason for Leaving:
(Required)
Supervisor's Name & Title:
(Required)
May we contact?
(Required)
Yes
No
Description of Duties:
(Required)
Employer #2:
Employer Address:
Street Address
Address Line 2
City
State
ZIP / Postal Code
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Position Held:
Reason for Leaving:
Supervisor's Name & Title:
May we contact?
Yes
No
Description of Duties:
Employer #3:
Employer Address:
Street Address
Address Line 2
City
State
ZIP / Postal Code
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Position Held:
Reason for Leaving:
Supervisor's Name & Title:
May we contact?
Yes
No
Description of Duties:
Employer #4:
Employer Address:
Street Address
Address Line 2
City
State
ZIP / Postal Code
From:
MM slash DD slash YYYY
To:
MM slash DD slash YYYY
Position Held:
Reason for Leaving:
Supervisor's Name & Title:
May we contact?
Yes
No
Description of Duties:
References
Identify three persons we may contact who know your work, beginning with the most recent. Please note that references will not be checked until later in the interview process.
Reference #1 Name:
(Required)
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
ZIP / Postal Code
Position or Title:
(Required)
Years Known
(Required)
Please enter a number from
0
to
100
.
Reference #2 Name:
(Required)
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
ZIP / Postal Code
Position or Title:
(Required)
Years Known
(Required)
Please enter a number from
0
to
100
.
Reference #3 Name:
(Required)
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
ZIP / Postal Code
Position or Title:
(Required)
Years Known
(Required)
Please enter a number from
0
to
100
.
Authorization and Acknowledgements
I certify that all information I have provided in order to apply for and secure work with Stumm Insurance, LLC. is true, complete and correct. I understand that my information provided by me that is found to be false, incomplete or misrepresented in my respect will be sufficient cause to (I) cancel further consideration of this application, or (II) immediately discharge me from the employer’s service, whenever it is discovered. I understand that if I am hired my employment shall be considered “at will” and may be terminated by this company at any time without liability for wages or salary except for such as may have been earned at the date of such termination unless or until superseded by specific written employment contract. I also understand that nothing in this application should be considered as an offer of employment by Stumm Insurance, LLC. I acknowledge that if I need reasonable accommodation in either the application process or employment, I should bring it to attention of the interviewer or Human Resources Department. I authorize the company to verify my references, record of employment, education record, and any other information I have provided. Unless otherwise noted, I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.
Please check the box to agree to the authorization and acknowledgements above.
(Required)
I agree
Date
(Required)
MM slash DD slash YYYY
