Application for Employment

It is our policy to provide equal employment opportunities to all qualified persons without regard to race, age, color, sex, religion, national origin, disability, marital status, sexual orientation, veteran status or any other prohibited criterion. This application for employment will be inactive after ninety (90) days. If you want to be considered after that time, you must complete a new application for employment.

PLEASE PRINT CLEARLY. COMPLETE FULLY, EVEN IF YOU PROVIDE A RESUME.

PERSONAL DATA:

JOB REQUIREMENTS:

EMPLOYMENT EXPERIENCE:

Company Name, Address, Phone Number and Supervisor's Name

Company Name, Address, Phone Number and Supervisor's Name

Company Name, Address, Phone Number and Supervisor's Name

EDUCATION AND TRAINING:

Name and Address of School

Type of Degree or Certificate and Major:

Grade Average out of base:

Name and Address of School

Type of Degree or Certificate and Major:

Grade Average out of base:

Name and Address of School

Type of Degree or Certificate and Major:

Grade Average out of base:

Please outline other training, activities, volunteer work, or additional experience that might be helpful to us in considering you for employment:

APPLICANT'S CERTIFICATION:

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that false statements on this application shall result in the denial or immediate termination of my employment. I hereby authorize the company to conduct a thorough background investigation in order to verify the information provided in this application and to assess my suitability for employment, and I release from all liability Premier Adjusters, Inc. and all affiliated entities and all persons, companies, and corporations supplying such information. I understand that the falsification, omission or misrepresentation of fact on this application (or any other accompanying or required documents) may be cause for denial of employment or immediate termination of employment if hired, regardless of when or how discovered.

If you do not authorize Premier Adjusters, Inc., to conduct your background investigation, you will not be considered for employment, promotion, re-assignment or contract at Premier Adjusters, Inc. If so, your application may be withdrawn, you may be removed from your position or your contract may be terminated, if applicable.

EMPLOYMENT AT WILL - Premier Adjusters, Inc. and its Affiliated Entities ("Company"):
I understand that I will be employed at will, with no express or implied employment contract. I understand that either I, or Premier Adjusters, Inc., have the right to terminate the employment relationship at any time, with or without cause and with or without notice. No officer or employee of the Company has the authority to alter or amend this relationship, except the President of the Company who may do so only in writing. Any earlier oral or written promises or statements regarding my employment termination that may have been made are void and superseded.

Please note: You will be required to provide an additional copy of this document with your handwritten signature.

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