1. APPLICATION FOR TRANSFER
Applicant Instructions:
Complete in full. To send this application to Human Resources, select “File | Save As” at the top left of
your browser, save the form onto your hard drive. Send an e-mail to HR.Applications and attach the
saved form. You may also attach a resume or other Word documents to the e-mail.
NOTE: Your supervisor will be notified of your application if you are selected to be interviewed.
NAME
OFFICE
DEPT
PHONE EXT
CURRENT POSITION
JOB CLASS
YRS./MTHS IN CURRENT POSITION
POSITION APPLIED FOR
OFFICE
DEPT.
There will be no discrimination in employment within the Utica National Insurance Group based on handicap, race, color religion, sex, national
origin or age. Please answer each question fully and accurately. Misrepresentations in furnishing this information will be cause for immediate
dismissal from any position thus obtained. The use of this blank does not indicate that there are any positions open, and does not in any way
obligate the Group.
Name and Address
Education & Training
Major
No.Yrs.
Attended
High School
College/University
Trade, Business,
Correspondence, Insurance
Post Graduate
Did You
Graduate?
Yes
No
Yes
No
Yes
No
Yes
No
Degree or
Diploma
Other Training, experience, or activities related to your ability to do the job applied for (include volunteer or hobby experience as
appropriate).
Business Experience
Show your employment history (including Utica National) for the past ten years – last position first.
Include military service, if any.
No Yrs.
E
m
plo
ye
d
Show All
Positi
ons
Held
Name & Address
of Employer
Type of
Busi
ness
Annual
Sa
lar
y
Supervisor(s)
Reason for
Leaving
Applicant’s Signature
Date
For Human Resources Department Use:
Interviewed?
Yes
Date Supervisor Advised
Transfer:
Offer Accepted
Date Applicant Advised
Date Supervisor Advised
Notes:
2-R-276 Ed. 11-89
Date
No
Offer Rejected
By Whom
Not Selected
By Whom