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Apply to Work at Lumenasa Insurance
All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical/mental disability, medical condition, military/veteran status, genetic information, marital status, ethnicity, citizenship or immigration status, or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring an accommodation to complete the application and/or interview process should contact a management representative.
Position Applying For
Select
Agent
Advisor
Client Experience Officer
Business Development Officer
Date
Name (Full)
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Alt. Phone
Email
Employment Experience
List the names of your present or previous employers in chronological order with present or most recent employer listed first. Be sure to account for all periods of time. If self-employed, give company name and supply business references. Add an additional page if necessary.
Name of employer
Supervisor
May we contact?
Yes
No
Street Address
Phone
Date Employed From
Date Employed To
Job title and duties
Reason for leaving
Name of employer
Supervisor
May we contact?
Yes
No
Street Address
Phone
Date Employed From
Date Employed To
Job title and duties
Reason for leaving
Have you ever been involuntarily terminated or asked to resign from any job?
Yes
No
If yes, explain.
Explain any gaps in your employment history.
List any other experience, job-related skills, additional languages, or other qualifications that you believe should be considered.
Education
Describe your educational background in the table provided below.
High School
Diploma/Degree
Yes
No
Area of study/major
Trainings, skills, or activities
College/University
Diploma/Degree
Yes
No
Area of study/major
Trainings, skills, or activities
Graduate/ Professional School
Diploma/Degree
Yes
No
Area of study/major
Trainings, skills, or activities
Trade School
Diploma/Degree
Yes
No
Area of study/major
Specialized training, skills, or activities
Other
Diploma/Degree
Yes
No
Area of study/major
Specialized training, skills, or activities
Business and Professional References
List three professional references of individuals who are not related to you.
Name and Title
Relationship
Phone number or email
Name and Title
Phone number or email
Relationship
Name and Title
Relationship
Phone number or email
Personal References
List three people who know you well.
Name and Title
Relationship/Years Acquainted
Phone number or email
Name and Title
Relationship/Years Acquainted
Phone number or email
Name and Title
Relationship/Years Acquainted
Phone number or email
General Information
Have you ever used another name?
Yes
No
Is any additional information relative to name changes, use of an assumed name, or nickname necessary to enable a check on your work and educational record?
Yes
No
If yes to either of the above, explain:
Have you ever worked for this company before?
Yes
No
If yes, provide dates and position:
Do you have friends and/or relatives working for this company?
Yes
No
If yes, name(s) and relationship(s):
On what date are you available to begin work?
Are you available to work?
Full time
Part time
Shift work
Temporary
If hired, do you have a reliable means of transportation to and from work?
Yes
No
Can you travel if the position requires it?
Yes
No
Are you at least 18 years old?
Yes
No
Note: If under 18, hire is subject to verification that you are of minimum legal age.
If hired, can you present evidence of your identity and legal right to work in this country?
Yes
No
Are you able to perform the essential job functions of the job for which you are applying with or without reasonable accommodation?
Yes
No
Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions.
Applicant Statement and Agreement
Read and consent to each paragraph below. Ask if there is anything that you do not understand.
Consent
Yes, I Consent
I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the prior employers and references I have listed to disclose to the company any and all letters, reports, and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.
I, Consent
Yes, I Consent
In the event of my employment with the company, I understand that I am required to comply with all rules and regulations of the company.
I, Consent
Yes, I Consent
In the event of my employment with the company, I understand that I am required to comply with all rules and regulations of the company.
I, Consent
Yes, I Consent
If hired, I understand and agree that my employment with the company is at will and that neither I nor the company is required to continue the employment relationship for any specific term. I further understand that the company or I may terminate the employment relationship at any time, with or without cause, and with or without notice. I understand that the at-will status of my employment cannot be amended, modified, or altered in any way by any oral modifications.
I, Consent
Yes, I Consent
I understand that the safety of employees is extremely important to the company and that the company is committed to ensuring a safe working environment. I understand that I, and every employee, have a responsibility to prevent accidents and injuries by observing all safety procedures and guidelines and following the directions of my site supervisor. I understand and agree to comply with federal, state, and local regulations related to onthe-job safety and health.
I, Consent
Yes, I Consent
I hereby certify that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I, Consent
Yes, I Consent
I understand that if I am selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration law requires me to complete an I-9 Form in this regard.
I, Consent
Yes, I Consent
I understand that if any term, provision, or portion of this Agreement is declared void or unenforceable, it shall be severed, and the remainder of this Agreement shall be enforceable.
My signature attests to the fact that I have read, understand, and agree to all of the above terms.
Signature
Name (print)
Date
Close Menu
About
Our Story
Our Team
Find an Agent
Why Lumenasa?
Testimonials
Contact Us
Insurance
PERSONAL
Auto Insurance
Homeowners Insurance
Renters Insurance
Condo Insurance
Umbrella Insurance
Mexico Insurance
Motorcycle Insurance
Recreational Vehicle Insurance
Valuable Items Insurance
Watercraft & Boat Insurance
Travel Insurance
Flood Insurance
Pet Insurance
Earthquake Insurance
Personal Cyber Insurance
BUSINESS
Business Owner’s Policy
General Liability Insurance
Commercial Property Insurance
Professional Liability (E&O)
Workers’ Compensation Insurance
Commercial Auto Insurance
Business Cyber Liability Insurance
Employment Practices Liability (EPLI)
Directors & Officers Insurance (D&O)
Umbrella & Excess Liability
LIFE
Term Life Insurance
Whole Life Insurance
Universal Life Insurance
Indexed Universal Life (IUL)
Final Expense Insurance
Key Person Life Insurance
Buy-Sell Agreement Funding
HEALTH
Individual & Family Health Insurance
Group Health Insurance
Small Business Health Plans
Medicare Supplement Plans
Medicare Advantage Plans
Prescription Drug Plans (Part D)
Short-Term Health Insurance
PRIVATE CLIENT
High-Value Home Insurance
Luxury Auto Insurance
Collections & Valuables Insurance
Personal Umbrella & Excess Liability
Secondary Homes & Vacation Properties
Domestic Staff Coverage
Yacht & Aviation Insurance
Resources
Self Service Portal
Learning Center
File A Claim
Make A Payment
FAQs
Get Service
Get A Quote
CALL US (855) 210-1301
Client Portal
Employee Portal
Agent Portal
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facebook
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