Your Email * Employment Position Position you are applying for? How did you hear about this position? Salary desired Personal Information Are you 18 years of age or older? Are you a U.S. citizen or approved to work in the United States? What document can you provide as proof of citizenship or legal status? Do you have any condition which would require job accommodations? Have you ever been convicted of a criminal offense (felony or misdemeanor)?
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense.
The date of the offense, the nature of the offense, including any significant details that affect the
description of the event, and the surrounding circumstances and the relevance of the offense to the
position(s) applied for may, however, be considered.)
Job Skills/Qualifications Please list below the skills and qualifications you possess for the position for which you are applying: Education and Training High School High School Location (City, State) Year Graduated High School High School Degree Earned College / University College / University Location College / University Year Graduated College / University Degree Earned Vocational School/Specialized Training Name Vocational School/Specialized Training Location Vocational School/Specialized Training Year Graduated Vocational School/Specialized Training Degree Military Are you a member of the Armed Services? What branch of the military did you enlist? What was your military rank when discharged? How many years did you serve in the military? What military skills do you possess that would be an asset for this position? Previous Employment 1 Employer Name Job Title Supervisor Name Employer Telephone Dates Employed Reason for leaving Previous Employment 2 Employer Name Job Title Supervisor Name Employer Telephone Dates Employed Reason for leaving Previous Employment 3 Employer Name Job Title Supervisor Name Employer Telephone Dates Employed Reason for leaving References
Please provide 2 personal and professional reference(s)
Reference Contact Information Reference Contact Information AT-WILL EMPLOYMENT
The relationship between you and the Larry Gordon Agency Inc is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause,
with or without notice, by you or the Larry Gordon Agency Inc. No representative of Larry Gordon Agency Inc has authority to enter into any agreement contrary to the foregoing "employment at will"
relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment
status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President
Type Your Name to Confirm Your Signature Dated Upload your Resume
pdf and doc format only please