CIS Group - Employment Application

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CIS Group - Independent Supplier Registration

Contact Information

Last Name:
First Name:

Address:
City:
State:
Zip:

Email:
Home Phone:
Cell Phone:
Fax Number:

Personal Information

Have you ever worked under another name?	YesNo
If yes, list names.

Are you over 18 years old?	YesNo
Do you have a general liability policy in place?	YesNo
How did you hear about CIS Group?
Were you referred to CIS Group? If yes, by whom?

Have you previously applied to our company?	YesNo
If yes, when?

Have you ever been a supplier for our company?	YesNo
If yes, when?

If hired/approved to be a supplier, can you submit verification of your identity and legal right to work within the United States?	YesNo

Have you been convicted of a misdemeanor or felony within the past seven years? (Do not include convictions that have been sealed, expunged or statutorily eradicated.)	YesNo
If yes, give date, place, offense and outcome.

Have you been dishonorably discharged from the military?	YesNo

Experience

Do you have any insurance inspection experience?	YesNo
If yes, please list the companies that you have completed inspections for in the past, both insurance companies and/or field survey companies.

Approximately how many of the following inspection types have you performed?
Exterior Condition and Hazard:
Interior Condition and Hazard:
Insured To Value:
High Value:
Wildfire/Brush:
Roof:
Claims related:
Heating and Electrical:
Woodstove:
Commercial:
If commercial, what types?	AutoHomeownersCommercial

Do you have experience completing narrative reports?	YesNo

Do you have any technical training in residential/commercial construction?	YesNo
If yes, please specify.

Are you physically able to climb a ladder?	YesNo

Computer Skills & Equipment

Do you own a home PC?	YesNo
Do you have high speed internet access?	YesNo
Do you own or have access to a fax machine?	YesNo

Do you have Microsoft Word and Excel?	YesNo
What is your Microsoft Excel proficiency?	BeginnerIntermediateAdvanced
What is your Microsoft Word proficiency?	BeginnerIntermediateAdvanced

Do you have experience using a PDA?	YesNo
If yes, Palm OS or Pocket Windows?	Palm OSPocket Windows
Do you use navigational tools such as Microsoft Streets and Trips?	YesNo

Do you have a digital camera?	YesNo
How many mega pixels?
Does your camera have a low resolution setting?	YesNo
Does your camera have an optical zoom?	YesNo

Do you have a ladder?	YesNo
Do you have measuring equipment?	YesNo

Availability

How many hours per week are you available to work inspections?
When are you able to begin work?
What mileage radius from your home seed point are you able to cover?
Please provide a list of cities and/or counties you are willing to cover.

References

Name:
Phone:

Name:
Phone:

Name:
Phone:

Resume Upload

Signature

CIS Group does not discriminate because of sex, age, race, color, religion, marital status, national origin, ancestry, disability, sexual orientation or veteran status.

By submitting this form, I certify that the preceding information, the information on my resume I have submitted, and the information supplied during the interview process is true, correct and complete to the best of my knowledge. I understand that false or misleading information or omissions on the application, resume and/or during the interview process may disqualify me from further consideration for employment or supplier work and may also be grounds for immediate termination of employment or contract, if I am hired or approved to be a supplier. I authorize CIS Group LLC and/or its designees to conduct a thorough investigation of the statements made on this application resume, or during the interview process, including but not limited to my prior employment history, conviction history, and agree to cooperate in said investigation. Also, I hereby release from all liability and responsibility all persons or corporations requesting or supplying such information.

Applicant Initials: