Employment

Lassiter Ware Insurance, Inc, is an equal opportunity employer and will consider all applicants for all positions equally without regard to their race, sex, age, color, religion, national origin, marital status, veteran status or disability. Under the provisions of the ADA, we will make reasonable accomodations when necessary.

This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action can be taken on this application until all questions have been answered. All fields are required.

Please visit our Careers page to view all of our open positions.

Personal Information

Date:
Name:
Phone:
Address:
City:
State:
Zip Code:
Email:

Have you ever been convicted of any crime (excluding minor traffic violations) including DWI?:
Yes No

If yes, state the offense, location, date and disposition:

If the job for which you are applying requires driving, do you currently hold a valid drivers license?
Yes No

Employment Desired

Are you seeking: Full Time Part Time Temporary or Summer Employment?

Position Applied For:
Salary Desired:
Available Start Date:

Is there any reason that you would be unable or unwilling to perform any of these tasks required by this position you are applying for? Yes No

If yes, please describe:

Is there any reason that you would be unable or unwilling to report to work on time every day on a regular and consistent basis? Yes No

If yes, please describe:

Education (List Highest First)

Name of School:
Courses Studied:
Did you Graduate? Yes No
Diploma:

Name of School:
Courses Studied:
Did you Graduate? Yes No
Diploma:

Name of School:
Courses Studied:
Did you Graduate? Yes No
Diploma:

Name of School:
Courses Studied:
Did you Graduate? Yes No
Diploma:

List any Scholastic honors, offices held, and activities involved in during high school or college.

List and describe any other school or specialized training.

Work History

List the names and employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment, give firm name and supply business references

Please give Month and Year. Do not reference your resume.

Name of Employer:
Address:
City, State, Zip:
Nature of Business:
Duties:
Name and Title of Last Supervisor:
Reason for Leaving:
Employed From:
Employed To:
Starting Salary:
Ending Salary:
Name of Employer:
Address:
City, State, Zip:
Nature of Business:
Duties:
Name and Title of Last Supervisor:
Reason for Leaving:
Employed From:
Employed To:
Starting Salary:
Ending Salary:
Name of Employer:
Address:
City, State, Zip:
Nature of Business:
Duties:
Name and Title of Last Supervisor:
Reason for Leaving:
Employed From:
Employed To:
Starting Salary:
Ending Salary:
Name of Employer:
Address:
City, State, Zip:
Nature of Business:
Duties:
Name and Title of Last Supervisor:
Reason for Leaving:
Employed From:
Employed To:
Ending Salary:

Employment Conditions - Read Carefully Before Signing

By my signature below, I certify that all information provided on this application is true and accurate. I understand that any false statements, misrepresentation, or omissions made on this application will be considered sufficient cause for Lassiter Ware, Inc. to deny or terminate my employment upon discovery. I understand that employment with Lassiter Ware Inc., is "at will" and therefore for an indefinite period of time. If employed, I may terminate my employment at any time and Lassiter Ware Inc., may terminate or modify the employment relationship at any time, with or without motive or cause. I understand that I am not guaranteed a specific shift, schedule or work assignment or to work overtime. If employed by Lassiter Ware Inc., I will abide by its rules, regulations, policies and procedures.

I hereby authorize all individuals and organizations named or referred to on this application to answer all questions that may be asked and give all information that may be sought in connection with this application. This may include, but is not limited to work history, criminal records, licensure, certification, education and driving record. I also certify that any individual or organization furnishing information concerning me shall not be held accountable for giving this information. I hereby release said individuals and organizations from any and all liability that may be incurred as a result of furnishing such information.

Finally, I freely and voluntarily agree to undergo drug testing as part of the application process, or at any time during my employment with Lassiter Ware, Inc., I understand that either refusal to submit to the test or failure of the test per Lassiter Ware Inc., policy will disqualify me from consideration and/or continuation of my employment.

Electronic Signature:
Date: