Employment Application - MBAAdmin.com

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FAQs

Part 1/6 - Applicant Information

Last Name *

First Name *

M.I.

Street Address *

Apartment/Unit #

City *

State *

Zip *

Phone 1 *

Phone 1 Type *

Which position are you applying for?

Phone 2

Phone 2 Type

E-Mail Address *

Social Security Number

Desired Salary *

Type *

Are You A Citizen of the United States? *

Yes

No

If No, Are You Authorized to Work in the U.S.? *

Yes

No

If Hired, Would You Have A Reliable Means of Transportation to and From Work? *

Yes

No

Have You Ever Been Convicted of A Felony? *

Yes

No

If Yes, Explain *

Are You at Least 18 Years Old? *

Yes

No

If under 18, hire is subject to verification that you are of minimum age.

Are You Able to Perform the Essential Functions of the Job for Which You Are Applying, Either With or Without Reasonable Accommodations? *

Yes

No

How did you hear about MBA? *

MERCHANTS BENEFIT
ADMINISTRATION, INC.

Is a Third Party Administrator authorized by the Merchants Industry Fund Group Insurance Trust to administer, market and distribute products covered under their Trust Agreement. Currently, the Trust Agreement offers a group retiree Medical plan called Seniors Choice. MBA opened its doors in 1997 to handle the daily administration duties for the Trust. Although MBA has been open for 15+ years, the Principals have been involved with the Trust for over two decades.

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• To buy or Not to Buy Dental Insurance...That is the Question

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