Fred Loya Employment Application – Fill Out and Use

Employment Application

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

Title VII of the Civil Rights Act of 1964, as amended, protects applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy), national origin, disability, age, sex, or genetics.

Personal Information

Position Applying For

Please list desired location (City & State) :

Have you ever worked for us before?

Name:

To:

If yes, where?

Have you ever been convicted of a crime other a traffic violation? (By disclosing this information may not automatically disqualify you for employment)

If yes, explain:

Education

Additional General Information

List skills/trainings relevant to the position applying for:

Please describe why you would be an ideal candidate for the position applied for (In at least 50 words. If additional space in needed please attach a separate sheet) :

Military experience/training relevant to the position applying for:

Employment Experience (Starting with most recent)

Business References

I certify that the information given by me herein is true, accurate, and complete to the best of my knowledge.

I understand that, as part of Fred Loya Insurance Agency Inc. ("Loya") employment procedure, a routine inquiry may be made which will provide applicable information concerning my employment history, performance and character.

I understand that Loya may obtain consumer reports, consumer credit reports and/or investigate consumer reports about me, including a search of criminal records and verification of my education and employment history, in connection with this application or during my employment if hired. I have authorized or will be authorizing the obtaining of such reports obtained directly by Loya without the use of any third party provider. I hereby authorize all persons or businesses contacted by or on behalf of Loya about me to disclose to Loya any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. I also authorize the persons named as references to provide Loya with any pertinent information they may have regarding me. I further understand that my employment with Loya is subject to satisfactory completion of this investigation. In addition, I hereby fully release Loya, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigations or disclosures.

I understand any false answers or statements or implications made by me in the application, in any interview, or other documents shall be considered sufficient cause for denial of employment or termination of employment if I should be employed by Loya. I further understand that my employment with Loya is subject to the satisfactory completion of this investigation.

Additionally, I understand that nothing contained in this employment application or in the granting of an interview or in the conduct of such investigation is intended to create an employment contract between Loya and myself for either employment or for the providing of any benefit. No promises or representation regarding employment have been made to me and I understand no such promise, representation or guarantee, whenever made, whether written or oral, is binding upon Loya unless made in writing by the President of Loya. If any employment relationship is established, I understand that employment with Loya is "at will" and if hired, I acknowledge that I have the right to terminate employment, with or without advance notice, for any reason at all, at any time and that Loya retains the same right.

If employed, I agree to sign any and all documents, forms & agreements customarily requested by Loya of all new hires from time to time. In addition, if employed, I agree to sign Loya's Confidentiality Agreement, in which I agree to protect and not divulge any confidential information I have gained through employment with Loya.

If employed, I agree to sign Loya's Mutual Agreement to Arbitrate Claims and have all disputes resolved through the arbitral forum.

If offered employment with Loya, I understand that my employment is contingent upon the presentation of documents establishing my identity and eligibility to work in the United States. I also understand that if employed, I will be required to abide by all rules and regulations of Loya.

Signature: