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Join Our Team


Apply today for a position with our team. We are always looking for productive administrative staff, top producing agents, and great minds to assist and grow our business ventures. Come join our dynamic culture.

Please complete in full. By submitting this form, you certify that your answers are true and accurate to the best of your knowledge.

If this application leads to employment, you understand that false or misleading information in your application or interview may result in release of employment.

"Coming together is a beginning. Keeping together is progress.
Working together is success."                                                                                                                          -Henry Ford




Employment Application
Applicant Information
First Name *
Last Name *
Street *
City *
State *
ZIP / Postal Code *
Primary Phone Number *
E-Mail Address *
Social Security Number
Date Available
/ /
Position Applied For
Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
If yes, when?
Have you ever been convicted of a felony?
If yes, explain.
Education
High School (Name/Address/Years Attended/Diploma)
Did you graduate?
College (Name/Address/Years Attended/Degree)
Did you graduate?
Other (Name/Address/Years Attended/Diploma)
Did you graduate?
References
Please include Name, Relationship, and Company Contact Information
Previous Employment
Company Name *
Company Address
Company Phone Number
Supervisor
Job Title
Starting/Ending Salary
Starting/Ending Years of Employment
Responsibilities
May we contact your previous supervisor for a reference?
Reason for Leaving
Military Service
Branch / Rank at Discharge
Years of Enlistment
Type of Discharge
If other than honorable, explain.
Additional Information
Additional Comments
Please upload your current resume with any relevant addtional skills, references, or work history.
Submission Validation
Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Locations

2400 Eastgate Mall Suite 200
San Diego, CA 92121


701 Brickell Ave
Suite 1550
Miami, FL 33131


1645 Palm Bch Lks Blvd
Suite 360
W. Palm Beach, FL 33401


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Suite 324
Boca Raton, FL 33431

Contact Us Toll: (877) 927-9277 Fax: (877) 468-8206 info@Leibainsurance.com CA Lic: # 0I13798  FL Lic: # L095608 
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