X hits on this document

Word document

Municipal Entity Underwriting Application - page 21 / 34

86 views

0 shares

0 downloads

0 comments

21 / 34

Municipal Entity Underwriting Application

a.

Psychological or personality tests:

 Yes

 No

b.

Drug or alcohol tests:

 Yes

 No

c.

Pre employment offer medical tests:

 Yes

 No

12.

Have all your employment related policies and procedures been reviewed and approved by outside counsel?

If yes, when?  

By whom?  Firm:    Atty  

 Yes

 No

13.

Have all recommendations from that review been implemented?

If not, explain or provide timeframe for implementation.  

 Yes

 No

14.

Do you use an employment application during your hiring process?

If yes, does it contain:

 Yes

 No

a.

An employment at will statement?

 Yes

 No

b.

Authorization to check references & criminal conviction records?

 Yes

 No

c.

The applicant’s signature attesting that all representations are true?

 Yes

 No

d.

An equal employment opportunity statement ?

 Yes

 No

15.

Do you distribute an employment handbook to your employees?

If yes, does it contain:

 Yes

 No

a.

An employment at will statement?

 Yes

 No

b.

A written sexual and general harassment policy?

 Yes

 No

c.

A written equal employment opportunity statement?

 Yes

 No

d.

A written internal complaint procedure for discrimination and sexual harassment claims?

 Yes

 No

e.

If no, do you have written policies on all of the above that are distributed separately?

Specify any that are not.  

 Yes

 No

16.

Do you have a written disciplinary program?

If yes, is it distributed to supervisors in writing?

 Yes

 Yes

 No

 No

17.

Do you post, in places conspicuous to all employees and applicants for employment, all notices required by law?

 Yes

 No

18.

When requested by employees, do you distribute information as required by federal law regarding Family Medical Leave?

 Yes

 No

19.

Do you require that all employment terminations be reviewed by the personnel having human resources responsibilities?

 Yes

 No

20.

Have you informed supervisory personnel, in writing, of their responsibility to provide you with prompt notice of any claims, incidents, or allegations?

 Yes

 No

21.

Please attach each of the following, if they exist.

a.

Employee handbook

b.

Employment Application Form(s)

c.

Separation Agreement Form

d.

Employee grievance, disciplinary, termination, and out-placement procedures

e.

EEO and Discrimination and Sexual Harassment Policy

employee benefits coverage

Claims-Made Coverage:  Retro Date  - Occurrence Coverage

n/a

General Information

Expiring Information

Renewal Information

Premium

Excess Limit

Annual Aggregate Limit

21 of 3410/23/2007

Document info
Document views86
Page views86
Page last viewedSun Dec 04 13:24:17 UTC 2016
Pages34
Paragraphs84
Words498

Comments