Legal name of entity or entities to be insured.
|Preferred Method of Contact:|
The Officer designated as agent of the Company and of all Insured Persons to receive any and all notices from the Insurer or their
authorized representatives concerning this insurance.
|Business Entity Type:|
For example: Accounting Firm, Restaurant, Law Firm, etc.
How many years has the company been in business?
|Is training provided to employees regarding discrimination and bullying/harassment?:|
|Is the ENTITY currently considering or has it in the past three years been involved in any acquisitions, mergers or majordivestitures?:|
|Does the ENTITY use seasonal employees:|
|Has the turnover rate exceeded historical levels during the past two years?:|
|Are any layoffs, staff reductions, or plant, branch or office closings anticipated within the next two years?:|
|Does the Company make use of independent contractors:|
|Does the Company require the submission of an employment application for all applicants?:|
|Does the ENTITY have (check all that apply):|
|Does the Company have a Human Resources Department?:|
|If you have a human resources manual, does this manual contain policies and procedures addressing the following areas (check all that are applicable):|
|Are all employees provided with and required to acknowledge receipt of a handbook that addresses the areas detailed in the human resource manual:|
|Do all managerial and supervisory personnel (check all applicable):|
|Does the ENTITY use outside legal counsel for employment advice?:|
|If outside legal counsel is used, are they consulted prior to discharging an employee?:|
|Have there been during the last five years, or are there now pending, any employment related civil, criminal, administrative or arbitration proceedings (including any proceeding initiated before any provincial or federal human right commission or tribunal and/or the Equal Employment Opportunity Commission) brought against the Company or its Subsidiaries or any person proposed for this insurance in their capacity as either Director, Officer, or employee of the Company or its Subsidiaries?:|
|Have there been during the last five years, or are there now pending, criminal, administrative or arbitration proceedings by any customer, client or other third party against the Company, its subsidiaries or any person proposed for this insurance alleging discrimination, harassment or violations of civil rights based upon discrimination or harassment?:|
|Is the person completing this application or any Director or Officer proposed for this insurance aware of any fact, circumstance or situation involving the Company or its Subsidiaries which he or she has reason to believe might result in any future Employment Practices Claim?:|
Typical limits available are $500,000; $1,000,000; and $2,000,000
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