Blue Claims Service

Employment Application

This is an application for employment at Blue Claims Services, LLC.

Full Name
*
Address:
*
City:
*
State:
*
Zip Code:
*
Phone Number
*
Email Address
*
Type of Employment:
*
High School Attended:
*
Year of Graduation:
*
College:
*

Yes
No
Did you graduate?
Yes
No
If so, where did you attend college?
Degree / Major:
Employment History 1 - Place of Employment:
*
Job Title:
*
Start Date
*
End Date:
*
Brief Description / Job Overview:
*
Employment History 2 - Place of Employment:
*
Job Title:
*
Start Date
*
End Date:
*
Brief Description / Job Overview:
*
Employment History 3 - Place of Employment:
*
Job Title:
*
Start Date
*
End Date:
*
Brief Description / Job Overview:
*
Please list any skills that you possess:
Do you hold any licenses or certifications?
*
Yes
No
If so, please specify:
Reference 1 - Name
*
Job Title:
*
Email Address
Best Phone Number to Contact
*
Relationship:
*
Reference 2 - Name:
*
Job Title:
*
Email Address
Best Phone Number to Contact:
*
Relationship:
*
Reference 3 - Name:
*
Job Title:
*
Email Address
Best Phone Number to Contact:
*
Relationship:
*

Along with submitting this Employment Application Form, please send your resume to amy@blueclaims.com to complete the application process.

Thank you.

PHONE:
337-335-7563
EMAIL:
jason@blueclaims.com
FAX:
888-759-4309

INDEPENDENT ADJUSTING AGENCY