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      • High Value Homes Insurance in Bridgeport, WV
      • Flood Insurance in Bridgeport, WV
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Application for Employment


WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER


We consider applicants for all positions without discrimination based on race, color, religion, creed, gender, national origin, age, marital or veteran status, disability, or any other legally protected status.

Proof of citizenship or immigration status will be required upon employment.

 


How did you learn about us? *(Required)
Your Name *(Required)
Home Address *(Required)
Have you ever filed an application with us before? *(Required)
Have you ever been employed with us before? *(Required)
Are you currently employed? *(Required)
May we contact your present employer? *(Required)
Are you authorized to work lawfully in the United States? *(Required)
Will you now or in the future require United Security Agency to commence (“sponsor”) an immigration case in order to employ you (for example, H-1B or other employment-based immigration case)? This is sometimes called “sponsorship” for an employment-based visa status. *(Required)
Are you currently on “lay-off” status and subject to recall? *(Required)
Can you travel if the job requires? *(Required)
Have you ever been involuntarily terminated from a job? *(Required)

 

 

Education

TIP: CLICK THE PLUS "+" SYMBOL TO ADD ADDITIONAL ENTRY FIELDS.
High School
Name of School
Year Completed
 
Undergraduate College
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Diploma/Degree Level
 
Graduate Professional
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Other (Specify)
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Year Completed
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Speak, Read and Write Fluently:

 

 

Employment History

TIP: CLICK THE PLUS "+" SYMBOL TO ADD ADDITIONAL ENTRY FIELDS.
Past Employment
Employer
Address
Tel #
Job Title
Reason for Leaving
Start Date
End Date
 
Consent Required For Submission *(Required)

I certify that answers given herein are true and complete to the best of my knowledge.


I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.


I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT, IF HIRED, MY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION WOULD BE OF AN “AT WILL” NATURE, WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE THE EMPLOYEE AT ANY TIME AND FOR ANY OR NO REASON. IT IS FURTHER UNDERSTOOD THAT THIS “AT WILL” EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION.


In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

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United Security Agency • 139 W Main Street • Bridgeport, WV 26330
Licensed In the Following States: WV, PA, VA, OH, KY, NC, FL

Insurance coverage cannot be bound or changed via submission of any online form/application provided on this site. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly by a licensed agent.
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United Security Agency • 139 W Main Street • Bridgeport, WV 26330
Licensed In the Following States: WV, PA, VA, OH, KY, NC, FL

Insurance coverage cannot be bound or changed via submission of any online form/application provided on this site. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly by a licensed agent.
© 2025 All rights reserved

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