SMART Form – AmFam Submittal Questionnaire

SMART Form - AmFam Submittal Questionnaire

Contact Information

State

Client and Position Information

1. Has another company already submitted you for this position?*

YesNo

2. If you answered No to the question above, do you grant Smart Solutions permission to submit you for this position?*

YesNo

3. Have you ever worked as an employee at American Family Insurance before?*
YesNo If yes, please list Dates of Employment, Role, Department, Manager, and Reason for Leaving:

4. Have you ever worked as an contractor at American Family Insurance before?*
YesNo If yes, please list Dates of Employment, Role, Department, Manager, and Reason for Leaving:

5. Education: Please list your highest completed degree:*

6. In a paragraph or two, tell us about your experience as it relates to the position description.*

7. What work location(s) will you consider (check all that apply):*

100% onsite at client officeHybrid (dependent on client expectations)100% remote100% remote with occasion travel as needed (dependent on client expectations)

8. What is your earliest availability to start, if selected?*

Work Authorization

Are you legally authorized to work in the US?*

YesNo

Type of Visa

Expiration Date

Military Service

Have you ever served in the U.S. Armed Forces?*

YesNo

Branch of Service

Discharge Date

Rank

Prior Offenses

Have you ever been convicted of, plead guilty / no contest to, or had a suspended imposition of sentence for any offense (other than a minor traffic violation)?*

YesNo

If Yes, explain:

Criminal Charges

Do you have any criminal charges pending against you?*

YesNo

If Yes, explain:

Note: A conviction or pending charge will not necessarily exclude you from consideration. This information will be used only for job-related purposes and only to the extent permitted by law.

Other Information

Month/Day of Birth (Please use MM/DD format)*

Who is your Career Advisor?*

Read carefully before submitting!

I understand that employment offers may be contingent on the satisfactory completion of the following: reference checks, background checks, an office of foreign assets check, employment eligibility verification, and/or drug test, in order to satisfy the needs of our clients.

Smart Solutions, Inc. is an equal opportunity employer. Smart Solutions, Inc. does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex, sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I hereby certify that the facts set forth in the above Submittal Questionnaire are true and complete to the best of my knowledge. I understand that falsified statements of any kind or omissions of facts called for on this form, or on my resume, shall be considered sufficient basis for the denial of employment or immediate dismissal.

Do you certify?*

Yes