Employment Practices Liability Back To BUSINESS INSURANCE Please provide information on your business Type of business: * Year business was organized: * Do you have any subsidiaries:* YesNo If so, please describe: Please provide information about your employees Number of part-time employees:* Number of employees within salary range of $1 to $30,000: * Number of employees within salary range of $30,001 to $50,000:* Number of employees within salary range of $50,001 to $100,000: * Number of employees with a salary higher than $100,001: * Please provide information about your claims history Within the past 5 years, has any administrative hearing/claim been made or is now pending: * YesNo If so, please describe: Is any person aware of any fact or circumstance that may give rise to a claim under this policy: * YesNo If so, please describe: Please provide information about your procedures Do you have written policies/procedures on hiring and firing:* YesNo Do you have written policies/procedures on sexual harassment:* YesNo Do you have written policies/procedures on discrimination:* YesNo Do you have a human resource department:* YesNo Miscellaneous Information Has there been or is there expected to be any reduction in staff in the past/future 12 months: * YesNo If so, please describe: Do you have an "Employment at Will" statement:* YesNo Is employment practices liability coverage in place currently:* YesNo Click here if you answered "Yes" to the above question: Who is the current insurance carrier: When will this coverage expire: What date did you first have this coverage: Please provide contact information Contact name:* Email address:* Telephone number:* What is the best time to contact:* How did you hear about us: * I am a current customerA friendInternet search engineNewspaperOtherEmployee Comments or additional information: Thanks for providing this information. If we need to contact you for additional information, we will send you a message through the secure Message Center found in File Cabinet. You can view a copy of this request, and a copy of your ID card, by clicking on File Cabinet. You will receive an email confirming this request made By clicking the Submit Button you are agreeing to the Terms Conditions of doing business with our agency via the Internet. Click here to view the Terms & Conditions.