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If you are an Enroller and you would like Enroll Force to consider you as a candidate for our in-house or client enrollments, please submit your profile. You will receive a confirmation email once it has been received. You will then be contacted for potential involvement in any upcoming enrollments. Thank you for your time and we look forward to working with you sometime soon.

Enrollment Staffing Profile

* Required field * First Name:   Middle Initial:   * Last Name:   * Address:   * City:   * State:   -- Please select one -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Zip:    * Home Phone:   * Cell Phone:   Fax:   * Email:   * Home State:   -- Please select one -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * License #:       How long have you been a licensed insurance agent?  -- Please select one -- less than 1 year 1-2 years 2-4 years 4-5 years more than 5 years Type of Insurance and/or Securities Licenses Currently Held (check all that apply):    Life & Health    Property & Casualty    Securities Licenses (Please list.)       Other (Please list.)    Do you currently hold E&O coverage on yourself?   Yes    No What States are you licensed in? AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Are you bilingual? Yes    No   If yes, check all that apply Spanish German French Chinese Other (Please list)       One-on-One Experience: Yes    No      If yes, number of cases?  Call Center Experience: Yes    No      If yes, number of cases?  Web-based Experience:  Yes    No      If yes, number of cases?    Product Knowledge (Check your level of experience or knowledge about each product.)    Medical Limited Average Extensive    Dental Limited Average Extensive    Vision Limited Average Extensive    401K Limited Average Extensive    Basic Life Limited Average Extensive    Group Term Life Limited Average Extensive    Pre-paid Legal Limited Average Extensive    Whole Life Limited Average Extensive    Universal Life Limited Average Extensive    Term Life Limited Average Extensive    Critical Illness/Cancer Limited Average Extensive    Short-Term Disability Limited Average Extensive    Long-Term Disability Limited Average Extensive    Accident Insurance Limited Average Extensive    Hospital Indemnity Limited Average Extensive    Limited Medical Limited Average Extensive   Computer Competency (Check all that apply):    Word    Excel    PowerPoint    Internet    Email    Other (Please list.)       Web-based Enrollment Software (Please list.)       Stand-alone Enrollment Software (Please list.)      PERSONAL PREFERENCES Preferred Minimum Contract Labor Rate including Per Diem: $ Are you willing to travel?    Yes    No If yes, for how long at one time?    -- Please select one -- less than 1 week 1-2 weeks 2-3 weeks 3-4 weeks 4 or more weeks Hotel: Smoking Non-smoking Airline: Aisle Window Car Rental: Major Credit Card Debit Card NOTE: Most enrollment companies and brokers require you to get the liability coverage at your own expense, so check with your insurance company to see if you are covered in a rental car or if you can add this as a rider.   Closest Airports to Your Home: City and State Driving Distance

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