Application for Employment

Please list information with most recent experience first. Additional employment, not shown below, should be listed on a separate sheet.

List highest degree obtained.

I authorize Marshfield Insurance Agency, at the time of my application for employment or during the course of my employment, to obtain information from any source indicated regarding my education, experience, or character as it relates to the position in which I applied or in which I may be employed unless otherwise stated. I certify that the information contained in this application is true, complete, and correct to the best of my knowledge. I understand that falsification or omission of information may be cause for dismissal or rejection of the application. I agree that all statements made may be investigated.