Thank you for your level of interest in contracting with Legacy Insurance & Financial Services. We are excited to find our next new partner to get behind and launch an exceptional career.

Use this form to help us get to know you better. Each * is a required field. Some questions are beyond what is provided on many resume's. That said, we'd still like you to attach your resume below if you are not sure we already have it.

Note that when licensing and appointing in the financial services field significant background check activity is completed by state regulators and insurance carriers. Financial sales professionals are expected to be knowledgeable of their own financial information and negative issues.

Please attach your resume here.

First Name *

Last Name *

Phone *

Email *

City *

State *

Date of birth *

Are you currently employed or an active contractor/business owner? *

Yes

If so, please describe.

Possible date available.

Are you currently licensed to sell insurance or investment products? *

Yes

If so, please describe which licenses.

If you are not attaching a resume, describe your work experience here.

If not on a provided resume, describe your education here.

Describe any military service not provided in a resume to us.

List any part-time work, other business interests, or college that would continue after contracting.

Describe any civic or non-profit organizations you belong to.

Please list any bankruptcies you have ever had below. Note there is no ten-year limit regarding this information within this career field. Also include any foreclosures, judgements, garnishments, tax liens or other negative credit history.

Describe any negative criminal or regulatory history. This does not include general traffic tickets. Include any regulatory charges, fines, or claims of any kind.

If you have been a licensed financial sales agent before - Do you have any outstanding debt (chargebacks) or vectors with prior insurance carriers or other financial institutions you were once contracted to sell for? If you are at all unsure, check. *

Yes

If so, please describe.

Are you in arrears on child support? *

Yes

Are you a party to any lawsuit or litigation as an individual or corporate officer? *

Yes

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