Careers | Initiate Your Career Growth

Personal Information

First Name

Last Name

Email Address

Phone Number (123) 456-7890

Date of Birth

Home Address

City

Zip

Driver's License Number

Employment

Are you contracted with any other insurance agency?

Yes

Are legally eligible to work in the United States?

Yes

Are you willing to work weekends?

Yes

Please provide any additional information that you believe would be needed to know by your employer? (Allergies, background, etc.)

Additional Information

Professional Information

National Producer Number (NPN)

Resident License Number

States Licensed To Sell Insurance

Years of Medicare Experience

America's Health Insurance Plans (AHIP) Certification

Have you completed the annual AHIP certification required to sell Medicare insurance plans?

Yes

Do you have a 2-15 (Health & Life) or 2-40 (Health) license?

Yes

Additional Questions

Do you speak Spanish?

Yes

Do you have Errors and Omissions Insurance?

Yes

Are you willing to acquire more states under your license if needed?

Yes

Any Carrier portal Log in? (Humana, UHC, WellCare, Devoted, Anthem, Aetna or Cigna)

Yes

Documents Upload

Resume (Upload) Accepted file formats include PDF and Word.
(Max Size: 2MB)

Driver's License (Upload) Accepted file formats include PDF, Word, PNG, JPEG.
* Please upload a clear picture of the front and back of your Driver's License
(Max Size: 2MB)

Resident State License (Upload) Accepted file formats include PDF, Word, PNG, JPEG.
* FL residents can find their license in the DICE platform under "Print Licenses"
(Max Size: 2MB)

Proof of AHIP Certification (Upload) Accepted file formats include PDF, Word, PNG, JPEG.
(Max Size: 2MB)

Release Letter (Upload) Accepted file formats include PDF and Word.
(Max Size: 2MB)

Initiate Your Career Growth

Begin Your Professional Journey Today - Submit Your Application!

Personal Information

Employment

Professional Information

Additional Questions

Documents Upload