Castle Claims
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Employment Application

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Equal Opportunity Employer
In accordance with existing state and federal laws, we employ qualified personnel for all positions without regard to race, creed, color, sex, age, religion, or national origin. Selection of candidates for positions will be made upon the basis of demonstrated capability, competence, and appropriate experience.

Personal Data

Position Desired(*)
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Full Name(*)
Please type your full name.

Present Address(*)
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City(*)
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State(*)
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Zip code(*)
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Permanent Address(*)
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City(*)
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State(*)
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Zip code(*)
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Phone(*)
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E-mail(*)
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Educational Data

Do You Have A High School Diploma?
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If no, do you have a GED?
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Do you have any vocational/technical training?
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If yes, where did you attend school?
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High School Data

School or Institution and Location
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Major/Minor
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Diplomas, Degrees or Credits Earned
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Grade Point Average (GPA)
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College/University Data

School or Institution and Location
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Major/Minor
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Diplomas, Degrees or Credits Earned
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Grade Point Average (GPA)
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School or Institution and Location
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Major/Minor
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Diplomas, Degrees or Credits Earned
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Grade Point Average (GPA)
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Graduate Study Data

School or Institution and Location
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Major/Minor
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Diplomas, Degrees or Credits Earned
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Grade Point Average (GPA)
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School or Institution and Location
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Major/Minor
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Diplomas, Degrees or Credits Earned
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Grade Point Average (GPA)
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Experience (present or most recent first)

Employer Name
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Employer Address
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Your Position
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Start Date
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End Date
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Name and Title of Supervisor
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Final Yearly Salary
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Work Performed
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Reason for Leaving
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Employer Name
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Employer Address
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Your Position
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Start Date
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End Date
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Name and Title of Supervisor
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Final Yearly Salary
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Work Performed
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Reason for Leaving
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Employer Name
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Employer Address
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Your Position
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Start Date
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End Date
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Name and Title of Supervisor
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Final Yearly Salary
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Work Performed
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Reason for Leaving
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Employer Name
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Employer Address
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Your Position
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Start Date
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End Date
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Name and Title of Supervisor
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Final Yearly Salary
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Work Performed
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Reason for Leaving
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Other Qualifications

Summarize special job-related skills and qualifications acquired from employment or other experiences (including U.S. military service) and/or state any additional information you feel may be helpful in considering your application, i.e. honors, awards, activities, technology skills or professional development activities
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Please check each of the following kinds of work in which you have experience.

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Please check each of the following kinds of technology in which you have experience.

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If you chose other above, please explain
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General Background Information

You must give complete answers to all questions. If you answer "Yes" to any question, you must list all offenses, and for each conviction provide date of conviction and disposition, regardless of the date or location of occurrence. Conviction of a criminal offense is not a bar to employment in all cases. Each case is considered on its merits. Your answers will be verified with appropriate police records.

Criminal Offense includes felonies, misdemeanors, summary offenses and convictions resulting from a plea of "nolo contendere" (no contest).

Conviction is an adjudication of guilt and includes determinations before a court, a district justice or a magistrate, which results in a fine, sentence or probation.

You may omit: minor traffic violations, offenses committed before your 18th birthday which were adjudicated in juvenile court or under a Youth Offender Law, and any convictions which have been expunged by a court or for which you successfully completed an Accelerated Rehabilitative Disposition program.

Were you ever convicted of a criminal offense (felony)?
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Are you currently under charges for a criminal offense?
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Have you ever forfeited bond or collateral in connection with a criminal offense?
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Within the last ten years, have you been fired from any job for any reason?
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Within the last ten years, have you quit a job after being notified that you would be fired?
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Are you subject to any visa or immigration status, which would prevent lawful employment?
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If you answered "Yes" to any of the above questions, please provide a detailed explanation:
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References (Please list only one family member for a reference.)

Name
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Title
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Full Address
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Phone
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Name
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Title
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Full Address
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Phone
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Name
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Title
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Full Address
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Phone
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Name
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Title
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Full Address
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Phone
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Attach your Resume
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Accepted formats are: pdf, doc, docx, txt

Declarations

I declare that I understand that this is an application for a position only and does not imply any promises of employment on behalf of the Company.

I the undersigned applicant hereby declare that all of the information on this Application Employment Form is accurate and true and I understand that any falsehood or omission on my part may be grounds for future dismissal from the position or withdrawal of an offer of employment.

My electronic signature signifies my approval for the company to check my references and to verify my reason for leaving my prior employment.

Electronic Signature
By typing your name in the signature box below, you are indicating your intent to sign the relevant document or record and that this shall constitute your signature.

Signature(*)
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