Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. list for NIPR Join The TeamSelect Job Opening *--- Select Choice ---Seasonal Sales Agent - ACASeasonal Sales Agent - Health & LifeLicensed Sales Agent - Health OnlyLicensed Sales Agent - Health & LifeFirst Name *Last Name *Email *Address *Address Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Social Security NumberNational Producer Number *Date of Birth *What is the highest level of eduction you have completed?High School or High School Equivalency (GED, etc.)Some CollegeCertificate (Vocational Education, Trade, etc.)Associates DegreeBachelors DegreeMasters Degree or HigherFront Photo ID Drag & Drop Files, Choose Files to Upload Back Photo ID Drag & Drop Files, Choose Files to Upload Upload NIPR Report Drag & Drop Files, Choose Files to Upload Upload Resume Drag & Drop Files, Choose Files to Upload Please list all languages you speakTell us about your most recent employment? (Company Name, Position, Employment Dates, Job Functions, and responsibilities, if applicacable reason for leaving)What's your employment status?StudentEmployedUnemployedOtherHave you been convicted of a felony in the past five years? A conviction does not automatically disqualify you but may affect your eligibility for state licensing.YesNoWhat is your earliest available start date?Referral source (if applicable)Submit
