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CMS EMPLOYMENT APPLICATION

Catastrophe Management Solutions is an affirmative action/equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

Read more information about your rights under equal employment opportunity laws.

This employment application is used by Catastrophe Management Solutions and all of its affiliated and/or subsidiary companies. Do not leave any items unanswered.

Notice to Applicants: The following matters will generally restrict an applicant from working for Catastrophe Management Solutions (This is not an exclusive list): Any conviction involving breach of trust (lying, cheating, stealing, etc.); any conviction involving violence; any conviction for bad checks or other evidence of mishandling of money or finances; any outstanding warrant; lack of a valid driver's license; under the age of 21; work as property or auto insurance agent or ownership of a property or auto insurance agency within the last 12 months.

Applicant Info

First Name:

Middle Name:

Last Name:

Nickname:

Current Address

Address:

Address 2:

City:

State:

Zip:

Previous Address

Address:

Address 2:

City:

State:

Zip:

Phone Number

Phone Number:

Phone Type:

Email

Email:

Text Messaging

Catastrophe Management Solutions uses text messaging as a method of rapidly communicating with our team. Please indicate if we may use text messaging when communicating with you:

Position Info

For what position are you applying?

What are your salary expectations?

For what location are you applying?

If hired, when could you start work?

How did you hear about our company?

Are you legally eligible for employment in the United States?

Please specify:
Please specify:

Background Information

List any criminal history that might prevent your employment within the insurance industry.

List the names of people you know who work for Catastrophe Management Solutions.

Name:

Relation:

Name:

Relation:

Driver's License

Driver License #:

Expiration Date:

State of Issue:

Employment History

Employer Title Start Date End Date

Education

Name Degree Major Years Completed Academic Achievements City State

References

Name Phone Relation Reference Years

Skills

Add Skills

Select a category from the list below to specify which skills apply to you.

Skill Years Additional Info
3D Modeling Programs
Computer Experience
Computer/Video Game
Data Entry
Drafting/AutoCAD
Financial Software
Graphics Software
Lotus
MS Access
MS Excel
MS Office
MS Outlook
MS PowerPoint
MS Publisher
MS Windows
MS Word
MS Works
Quickbooks
Quicken
SAP Software
Skill Years Additional Info
Arabic
Cambodian
Dutch
French
German
Greek
Italian
Japanese
Portuguese
Russian
Sign Language
Spanish
Ukranian
Vietnamese
Skill Years Additional Info
Call Center
Clerical
Customer Service
Keyboarding
Marketing
Notary Public
Office Equipment
Record Keeping
Retail
Sales
Secretarial
Telemarketing
  • Software
  • Language
  • Office

Equal Employment Opportunity Employer

Catastrophe Management Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment and does not discriminate on the basis of race, religion, color, sex, age, national origin, disability unrelated to ability to perform job duties, marital or veteran status (including Vietnam-era or special disabled veteran status), or any other legally protected status in accordance with all applicable laws governing nondiscrimination in employment at every Company facility. This policy extends to all terms and conditions of employment including, but not limited to, hiring, promotion, termination, layoff, recall from layoff, transfers, developmental and educational opportunities, leaves of absence and compensation.

To further the principle of equal employment opportunity within our Company and to comply with governmental regulations, Catastrophe Management Solutions has developed Affirmative Action plans for minorities, women, the disabled and Vietnam-era and special disabled veterans. The below requested applicant data is used by Catastrophe Management Solutions to comply with government recordkeeping, reporting and other legal requirements.

Special Note

Your cooperation in providing this information is voluntary. This information is maintained separately from all other employment-related documents. The information or lack of information requested on this form will not affect employment decisions.

EEO Information

Name:

Date:

Gender:

Social Security Number:

Ethnic Origin:

Signature

NOTICE TO ALL APPLICANTS: IT IS IMPORTANT THAT YOU READ THE SECTION BELOW PRIOR TO EXECUTING THIS APPLICATION.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. By executing and submitting this application, I certify that I am genuinely interested in working in the position(s) for which I have applied and am making this application for no other purpose. I understand that any misrepresentation or omission is grounds for immediate termination of employment or refusal to hire.

I understand that Catastrophe Management Solutions will conduct an investigation into my employment qualifications and fitness for employment. I hereby consent to have an investigation made by Catastrophe Management Solutions. I also authorize and request every person, company, governmental agency, schools and/or institutions having control of any documents, records, and other information pertaining to me to allow Catastrophe Management Solutions to inspect and copy any such documents and records. I agree to release Catastrophe Management Solutions and its agents and representatives, and any person or entity furnishing oral reports and any written documents and records, or other information from any and all liability that may result from furnishing this information. I also agree to sign separate documentation authorizing Catastrophe Management Solutions to obtain a consumer report on me for employment purposes.

I agree to confirm the policies, procedures, rules, and regulations of Catastrophe Management Solutions. I also agree that my employment is at-will and can be terminated at any time by me or Catastrophe Management Solutions, with or without cause and with or without notice. I further understand that no one employed by Catastrophe Management Solutions has the authority to enter into any employment agreement for any specified duration or to make any agreement contrary to the foregoing.

I understand that Catastrophe Management Solutions may employ knowledge, skills, and abilities testing in its employment process and that employment with Catastrophe Management Solutions will be contingent upon the successful completion of such tests. If required for my job classification, I understand that my employment will be contingent upon the successful completion of a post-offer employment physical examination and/or drug and alcohol screening. I agree that the results of these tests may be released to Catastrophe Management Solutions. I understand that I may also be required to undergo drug and/or alcohol testing at other times if I am employed by Catastrophe Management Solutions.

NOTICE TO ALL APPLICANTS: IT IS IMPORTANT THAT YOU READ THE SECTION BELOW PRIOR TO SIGNING AND DATING THIS APPLICATION

Applicant and Catastrophe Management Solutions have agreed that Applicant will complete and execute his or her application by electronic means and that Catastrophe Management Solutions will accept delivery of the application by electronic means. Execution of the application shall be accomplished through electronic means by the individual's typing his or her name in the place provided for the signature of the Applicant. The Applicant further acknowledges that he or she adopts the typing of his or her name in the place provided as part of the application as his or her signature for purposes of electronic completion of the application.

Applicant Signature:

Date:

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