First Name *

Last Name *

Phone *

Email *

I agree to be contacted by Equity Premier Partners by phone, text and email about my application. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help.

I understand this is an independent contractor role paid on commission, not a salaried position.

Instagram handle

State you live in *

Do you hold an active life insurance license? *

Yes, I am licensed

In progress (studying or exam scheduled)

No, not yet

National Producer Number (NPN)

We look this up before scheduling an interview. The name on the license must match your name above.

States you are licensed in

Current situation

Captive agency

Independent or brokerage

Licensed but not currently selling

Are you currently contracted under another agency or upline?

Yes, and I can get a release

Yes, and I am not sure about a release

Average monthly submitted premium over the last 3 months

Not selling yet

Under $5,000

$5,000 to $15,000

$15,000 to $30,000

Over $30,000

Do you currently owe a balance to any carrier or upline?

Yes

Chargebacks or debit balances. Answering yes does not rule you out, but we need to know up front.

If yes, with whom and roughly how much?

Sales experience

None yet

Under 1 year

1 to 3 years

More than 3 years

Can you finish the pre-licensing course and take your state exam within the next 30 days?

Yes

No license is fine. Your pre-licensing course is paid for.

Hours per week you can commit *

Under 20

20 to 30

30 to 40

40 or more

When could you start? *

Right away

Within 2 weeks

Within 30 days

Just exploring for now

Why do you want to make a move, and what are you looking for? *

This is the answer we read most closely.

How did you hear about us? *

Instagram

Referred by someone on the team

Other

If you were referred, who referred you?

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