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First Name
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Last Name
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Mobile Phone
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Email
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Address
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City
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State
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What are your top priorities? Select 3-5.
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Being part of a team
Positive company culture
Salary potential
Independence
Having a fulfilling career
Flexible schedule
Recognition
Training and ongoing professional development
Advancement opportunities
Other
Rate your interest in this career on a scale from 1 to 10 AFTER watching the career videos
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Think of a 1 being "You guys are great but I am considering LOTS of other options" and a 10 being "Holy smokes! This checks all the boxes for me and I would do really well - PICK ME!!"
Why did you give this rating?
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What attracts you most to a career with our agency?
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What are your core values (what matters most to you) in life?
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What are 3 characteristics that have helped you be successful in your career(s)?
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What are two of your weak points that you want to improve on?
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What are you looking to avoid in a career?
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Do you have a valid Driver's License and reliable transportation?
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Are there any limitations on your schedule or ability to travel?
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if yes, please explain
Can you afford the upfront cost of getting licensed?
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Yes
No
Every state requires a license to sell insurance; the cost typically ranges from $200 - $350. We offer a licensing incentive and will reimburse your licensing costs after you have sold a certain amount of premium.
Do you have any criminal history?
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Yes
No
Traffic offenses and many misdemeanors are acceptable, but felonies and pending charges may bar you from obtaining a license. List any criminal, financial, etc information that will be found on a extensive background check.
If Yes, please describe
Who did you speak with initially about the position?
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