Online Interview

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First Name






Last Name






Address







City





State





ZIP Code





Phone





Email





Employment History

Current Employer:
Current Position:
Previous Employer:
Previous Position:


Education:




How many years of education have you completed?
Some High School
H.S. Diploma or equivalent
Some College
2-Year College Degree
4-Year College Degree
Beyond 4-year College Degree




Do you have, or are you pursuing professional certification?
Possess certification
Pursuing certification
Do not have and are not pursuing certification




Do you have a current life, health, variable license?
Yes
No


Experience:




How many years experience do you have in the position for which you are interested?
No experience
Less than one year
At least 1 to 3 years
At least 4 to 6 years
At least 7 to 9 years
Ten or more years




What type of employer BEST matches your experience?
No experience
Insurance Company
Insurance Broker
Claims Investigation Company
Business or Corporate Insurance Department
Other




What type of claims BEST matches your experience?
No experience
Medical/Health
Automobile
Property and Casualty
Life
Workers Compensation
General Liability
Personal Injury
Other




Do you have customer service experience with new and existing customers?
Yes
No




Do you have telemarketing experience to develop and qualify leads?
Yes
No




Do you have experience with more than one type of insurance product?
Yes
No




Do you have experience illustrating and selling financial products?
Yes
No




Do you have experience with claims verification?
Yes
No




Do you have experience with claims investigation?
Yes
No




Do you have experience writing and sending clients correspondence?
Yes
No




Do you have experience with specific client input or management software?
Yes
No




Do you have experience resolving account issues with customers or vendors?
Yes
No




Do you have experience with preparing financial statements and reports?
Yes
No




Do you have any experience managing or supervising others in your department?
Yes
No


Work/Salary:




Please indicate the method of compensation you prefer:
Base salary
Base salary plus commission
Performance-based commission only
Flexible




Please indicate what salary you are looking to receive:
Up to $20,000
Up to $25,000
Up to $30,000
Up to $35,000
Up to $40,000
Up to $45,000
Up to $50,000
Up to $60,000
$60,000 or more


General:




Are you interested in working full time or part time?
Full time
Part time




Are you currently employed?
Yes
No




How many employers have you worked for in the past five years?
One
Two
Three
Four
Five or more




How many days of work (other than vacation or approved time off) have you missed in the past year?
None
1 to 4 Days
5 to 10 Days
More than 10 days




How many miles from your home are you willing to travel to work?
Up to 5 miles
Up to 10 miles
Up to 20 miles
Over 20 miles




Are you at least 18 years of age and eligible to work in the United States?
Yes
No




In addition to English, in which language are you most fluent?
Spanish
French
Italian
German
Russian
Chinese
Japanese
Other
None




Are you bi-lingual or multi-lingual?
Yes
No




Would you consent to pre-commencement testing, if required, including drug screening, medical testing and/or skill-related testing?
Yes
No




Would you consent to pre-employment background checks, if required, including past employment information, education verification, and/or reference checks?
Yes
No




Are you now or have you been a member of the United States Military, National Guard or Reserves?
No
I am a Veteran of the United States military
I am currently a member of the United States military
I am currently a member of the National Guard or Reserves
I was a member of the National Guard or Reserves



Please take a moment to briefly share any additional information about yourself that you feel a prospective employer would like to know. We do not recommend pasting of resumes or cover letters.


Additional Info:
 

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