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Online Employment Application


Incomplete applications will not be processed.  This application will be considered active for 180 days.  Any applicant wishing to be considered beyond this time period should submit another application.

Please note, this application is intended for use in evaluating your qualifications for employment.  This is not an employment contract.  Please answer all questions completely and accurately.  False or misleading statements on this form are grounds for termination of the application process, or, if discovered after employment, termination of employment.  Additional testing of job-related skills or for the presence of illegal drugs in your body may be required prior to employment.


Applicant Information
First Name
Required
Last Name
Required
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
E-Mail Address
Required
Position Information
Which position are you interested in?
Optional
Comments
Optional
Desired Salary
Optional
Willing to relocate?
Optional

Full-Time or Part-Time employment?
Optional

If Part-Time, how many hours per week are you available?
Optional
What date are you available to start?
Optional
/ /
Are you at least 18 years of age?
Optional

Citizenship Information
Are you prevented from being lawfully employed in this country due to a Visa or immigration status?
Optional

Education Information
High School Name
Optional
City
Optional
State
Optional
Receive High School Diploma?
Optional

College/University
Optional
City
Optional
State
Optional
How many years of college have you completed?
Optional
What is/was your course of study?
Optional
Please list all other schooling
Optional
Job Related Skills
Which agency management system(s) are you familiar with?
Optional




Working knowledge of Microsoft products? Check all that apply.
Optional



List knowledge of other computer programs:
Optional
List any other skills:
Optional
List any licenses or certifications you have that would be of value to this job or company
Optional
Security
Have you ever been bonded in prior employment?
Optional

Have you ever been convicted of a misdemeanor or a felony?
Required

If Yes, please explain
Optional
Background Authorization
If I am interviewed and accept employment, I agree to allow Texas Associates to investigate my background
Optional

Employment Experience
Please go back 5 years, listing your most recent employer first. Include any gaps in employment and state the reason for no employment during this period
Employer
Optional
Address
Optional
City
Optional
State
Optional
Zip
Optional
Phone
Optional
Job Title
Optional
Supervisor
Optional
Start Date
Optional
End Date
Optional
Starting Salary/Hourly Wage
Optional
Ending Salary/Hourly Wage
Optional
Reason for Leaving
Optional
____________________________________________
Employer
Optional
Address
Optional
City
Optional
State
Optional
Zip
Optional
Phone
Optional
Job Title
Optional
Supervisor
Optional
Start Date
Optional
End Date
Optional
Starting Salary/Hourly Wage
Optional
Ending Salary/Hourly Wage
Optional
Reason for Leaving
Optional
____________________________________________
Employer
Optional
Address
Optional
City
Optional
State
Optional
Zip
Optional
Phone
Optional
Job Title
Optional
Supervisor
Optional
Start Date
Optional
End Date
Optional
Starting Salary/Hourly Wage
Optional
Ending Salary/Hourly Wage
Optional
Reason for Leaving
Optional
Upload resume
Optional
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Contact Info

Texas Associates Insurors - Home Office
1120 Capital of Texas Hwy
Bldg 3-300
Austin, TX 78746

Ph: 800.765.4154
Ph: 512.328.7676
Fax: 512.327.8337

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