APPLICATION FOR EMPLOYMENT Full Name: Date of Applicaton: Positon Applied for: Desired Salary Range $: Home Phone # Cell #: Email: Date Available for Work: Note to Applicant: We appreciate your interest in our organization and assure you that we are interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications. To be considered for employment, fully complete the following honestly and legibly. Further, you are required to submit the following with this completed Application Form: A copy of your NIB card. A copy of your passport (or equivalent government I.D.). References from previous employers (if any). PERSONAL INFORMATION: First Name: Middle Name: Last Name: Nationality: National Insurance #: Passport #: Street Address: Postal Address: Date of Birth: Gender: Male Female Are you related to any current Insurance Management Employees?: Yes No If yes,then who?: Have you ever been convicted of a crime?: Yes No If yes, please describe in full: EDUCATION: Previous/Current Employer: Locaton: Year Graduated: Cumulative GPA: College/University: Locaton: Year Graduated: Cumulative GPA: Degree/Certificate: Other: Location: Year Graduated: Cumulative GPA: Degree/Certificate: Are you currently a4ending school?: Yes No If yes, what & where are you studying?: EMPLOYMENT HISTORY: Previous/Current Employer: Location: Phone: Direct Supervisor: Title/Positon: Start Date: End Date: Ending Salary: Responsibilities: Reason for Leaving: Are there any other experiences, skills, or qualifications which you feel would be beneficial to the Position in which you are applying for?: May we contact your previous employer’s / Supervisor’s for reference?: Yes No An employee caught stealing from the company, including the company’s time, should be terminated. Do you?: Agree Disagree Depends: Above all the other applicants, why should Insurance Management (Bahamas) Limited choose you?: Yes No Details: APPLICANT DISCLAIMER AND SIGNATURE I declare the information provided in this application is true and complete, and I understand that false or misleading information in my application or interview may result in my immediate release. Signature: Start Date:
New ProvidenceGrand Bahama Abaco Eleuthera Exuma