Careers

Gaylor Insurance may be the career for you!

Applicant Instructions
Incomplete applications will not be processed. This application will be considered active for 180 days. Any applicant wishing to be considered beyond this time period should submit another application.

Please note. This application is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements on this form are grounds for terminating the application process, or, if discovered after employment, terminating employment. Additional testing of job-related skills or for the presence of illegal drugs in your body may be required prior to employment.

Employment Form

Applicant Information

Address *
Address
City
State/Province
Zip/Postal

Position Information

$
Willing to relocate? *
Full Time or Part Time? *
Are you at least 18 years of age? *

Citizenship Information

Are you prevented from being lawfully employed in this country due to Visa or immigration status?

Education Information

Receive High School Diploma?

Job Related Skills

Mark all skills that apply

Security

Have you ever been bonded in prior employment?

Background Authorization

Checkboxes

Employment Experience

Please go back 5 years, listing your most recent employer first. Include any gaps in employment and state the reason for no employment during that period
Do you currently work here? *
Address of Employer *
Address of Employer
City
State/Province
Zip/Postal
$
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References

Include only individuals familiar with your work ability. Do not include relatives. Please do not include individuals to whom you directly reported in the last five years
Address *
Address
City
State/Province
Zip/Postal
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Additional Notes

Authorization

I hereby certify that I have a genuine interest in being hired and that all of the foregoing statements are true and correct. I agree to assume a continuing responsibility to disclose additional or new information, called for by this Employment Application, but known to me only after this Application was completed, and understand that my failure to make such a disclosure, and that falsification of any of the information given herein, on any employment form or in any interview, are grounds for immediate termination, regardless of when such failure or falsification may be discovered.

I also understand that my employment may be terminated at any time, with or without cause, without liability to me for salary, wages, or other benefits except as may have been earned up to date of the termination of services.

Please type your name.