EmailMe Form - APPLICANT ASSESSMENT

Name

First Last

City, State

Email

Phone

Please select the top 3 job characteristics which are most important to you:

After watching the video, rate your interest in a career with our company:

What appeals to you most about a career with us? Why?

What gives you confidence that you would do well here? Why?

What would you have changed about your last career? (i.e. what was missing?)

Every state requires a license to sell insurance that you would be responsible for obtaining (total licensing costs range from $175-300). We offer a sales incentive to reimburse your licensing expenses. Are you able to afford the initial cost to get licensed?

Yes

No

Our company does an extensive background check on all new agents. Is there anything on your record that could potentially show up on a background check?

Yes

No

If yes, please explain:

Not all history or offenses will prohibit employment, but may require further explanation. For example, most traffic offenses and many misdemeanors are acceptable. However, felonies, some misdemeanors and any pending charges may bar you from obtaining a license. List any criminal, financial, etc information that could be found on a extensive background check.