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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:   * Zip:   
* Home Phone:  
* Cell Phone:  
Fax:  
* Email:  
* Home State:  
* License #:  
   
How long have you been a licensed insurance agent? 
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?   
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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Enroll Force, LLC
503 Forrest Park Ct.
Huntsville, AL 35806
Office: (866) 606-6170
Fax: (256) 489-1002
Email : info@enrollforce.com