Employment Application

1Personal Information

2Previous Employment

3Employment Information

Southern Farm Bureau Casualty Insurance Company (SFBCIC) is an equal opportunity employer and provides equal employment, advancement opportunities, working conditions and benefits of employment regardless of race, color, creed, national origin, sex, age, marital status, sexual orientation or qualifying disability. SFB – Colorado Office will make reasonable accommodations to allow a disabled person who is otherwise qualified, to perform the job in question.
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Position applying for:*
Salary Requirements:
Are you a former SFBCIC Employee?*
- Yes
- No
Are you over 18 years of age?*
- Yes
- No
Upload your resume:
Please upload your resume to include with your completed application.
Max. file size: 200 MB.
Education:*
Please list education levels/degrees earned and the year of completion, along with school name and location.
Professional Skillsets
Please list any business/office related special skills or knowledge that you consider relevant. Examples may include accounting, typing, machine transcription, personal computer word processing and spreadsheet packages, computer programming, customer service, foreign languages, military training and/or related volunteer activities.
Professional certifications and/or accreditations:
References:*
Please list three business references who can evaluate your performance. Include their professional title, company or organization name, phone and email. Click + to add an additional row.
Name & Title Company/Organization Phone Email

Previous Employment
Use the following fields to enter information on up to three past (or current) positions starting with your present or most recent job. List employment for the past 7 years including verifiable self-employment and/or volunteer work. Please do not omit any jobs and/or employers.
Position:
Company/Organization Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Start Date:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Starting Salary:
Ending Salary:
Other Compensation:
Contact Name:
First Last
Contact Phone:
Reason for leaving:
May we contact?
- Yes
- No
Position:
Company/Organization Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Start Date:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Starting Salary:
Ending Salary:
Other Compensation:
Contact Name:
First Last
Contact Phone:
Reason for leaving:
May we contact?
- Yes
- No
Position:
Company/Organization Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Start Date:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Starting Salary:
Ending Salary:
Other Compensation:
Contact Name:
First Last
Contact Phone:
Reason for leaving:
May we contact?
- Yes
- No

If employed, could you furnish proof of citizenship or eligibility to work in the United States?
- Yes
- No
Do you have any relatives employed by Farm Bureau?
- Yes
- No
What is the name of the employee or agent?
Hidden
Have you ever been convicted of a felony?
- Yes
- No
Please explain the charges:

An applicant for employment with a sealed record on file with the Commissioner of Probation may answer “no record” with respect to any inquiry herein relative to prior arrests, criminal court appearance or convictions. An applicant for employment with a sealed record on file with the Commissioner of Probation may answer “no record” to an inquiry herein relative to prior arrest or criminal court appearances. In addition, any applicant for employment may answer “no record” with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services, which did not result in a complaint transferred to the superior court for criminal prosecution.
If you have employment or education records under any other name please provide:
Please enter your full name to act as your signature certifying the information on this form according to the following statement:*
I hereby certify that the information set forth in this employment application is accurate and complete. I understand that any misrepresentations or omissions on this application or accompanying employment related documents attached may be considered sufficient cause for rejection of this application or discharge if employed by SFBCIC – Colorado Office. I understand that I must meet any and all valid job-related requirements as a condition of initial and continued employment. Physical examinations may be required and could include testing for drugs and/or alcohol. I hereby authorize SFBCIC – Colorado Office to conduct any applicable investigations concerning my personal history, and financial and credit records through any investigative agencies or bureaus in accordance with the provisions set forth in the Fair Credit Reporting Act. Further, I release SFBCIC – Colorado Office and all persons, companies or corporations supplying such information from all liability or responsibility for any damages arising there from. If I am offered and I accept a position, in consideration of employment, I agree to the rules and regulations of the Company and understand that my employment is at will, and as such I can be terminated, with or without notice and with or without cause, at any time, at the option of either the Company or myself. I understand and agree that the application is neither an offer of employment, nor a contract. Employment is also conditional upon my ability to provide verification that I have the right to work in the United States in accordance with the Immigration Reform and Control Act of 1986.
Date of Signature:*
MM slash DD slash YYYY
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Name & Title	Company/Organization	Phone	Email

Employment Application (non-agent)

Previous Employment