GIB Job Application

Employment Application

Please contact us if you have any questions admin@globalinsurancebilling.com
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
What position would you like to apply for?*
Desired Hourly Rate *
Per Hour
Date Available*

MonthDayYear
Date
Upload Your Résumé

This will give us an opportunity to get to know your work history and skills better
Cancelof
Are you a citizen of the United States?*

YesNo
If no, are you authorized to work in the U.S.?*

YesNo
Have you ever been convicted of a felony?*

YesNo
If yes, please explain*
Thank you for considering this application. As part of our standard hiring procedure, we require a background check for all potential candidates. Before proceeding, we kindly request your consent to initiate these screenings. The results will be kept confidential and used solely for employment purposes. Please let us know if you have any concerns or questions regarding this process.*

I consentI do not consent
References

Please list three references
Name*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Name

First NameLast Name
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.
Previous Employment
Company*
Phone Number*
Please enter a valid phone number.
Website
Supervisor*

First NameLast Name
Job Title*
Starting Salary*
Ending Salary*
Responsibilities*
Starting Date*

MonthDayYear
Date
Ending Date

MonthDayYear
Date
Reason for leaving
May we contact your previous supervisor for a reference?*

YesNo
Company
Phone Number
Please enter a valid phone number.
Website
Supervisor

First NameLast Name
Job Title
Starting Salary
Ending Salary
Responsibilities
Starting Date

MonthDayYear
Date
Ending Date

MonthDayYear
Date
Reason for leaving
May we contact your previous supervisor for a reference?

YesNo
Military Service
Branch
From

MonthDayYear
Date
To

MonthDayYear
Date
Rank at discharge
Type of discharge
If other than honorable, please explain
Is there anything else you would like us to know about you?
How did you hear about this position?*
If referred, please provide details.
I, First Name Last Name certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature*

Clear
Date*

MonthDayYear
Today's date
Should be Empty:

Employment Application

References

Previous Employment

Military Service