Coakley Financial Group Agent Requisition Form

If you are interested in becoming a C² Group, a division of the Coakley Financial Group, Agent or are already a C² Group, a division of the Coakley Financial Group Agent, you must fill out our Pre-screening Questionnaire Recruits Form. Once you have completed this form and you have been contracted and approved, you will be able to gain access to the C² Group's, a division of the Coakley Financial Group, Online Insurance Training Academy. Note: You must reside in one of the following states: Delaware, Georgia, Maryland, New Jersey, South Carolina, Virginia or Washington DC.

Phone(*)
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Full Name(*)
Please type your full name.

E-mail(*)
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What State do you reside in?(*)
Please tell us which state you reside in?

You must reside in one our service area states

Zip Code(*)
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Please tell us a little about your sales experience.

What was your annual sales production last year?(*)
Please tell us about your last year's annual sales production.

What was your sales production last month?(*)
Please tell us about your last month's sales production.

How many hours a week do, or did you spend in the sales field?(*)
Please tell us how many hours you spend in the sales field calling or servicing customers.

What was/is your last or current Sales Position?(*)

Please specify your sales position in your last or current company

Are you currently licensed to sell Life Insurance?(*)

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Who are you licensed with and what products do you sell?(*)
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Tell us who you are currently licensed with and what products you sell

Are you Spanish or Bilingual?(*)

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How Long have you been licensed and what products have you sold?(*)
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Tell us how long you have been licensed and what products you have sold.

What do you like or dislike about your current position?(*)
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Tell us what you like or don't like about your current position

Why do you want to sell Final Expense?(*)
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Explain your reasons for wanting to sell Final Expense

What is your experience with Final Expense?(*)
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Briefly describe your experience with Final Expense

What are the most important things you desire from the company you represent? (*)
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Briefly describe what you desire from a company you would like to represent.

 
Could you sell someone just by stopping by their home without an appointment? Explain.(*)
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How would you say you deal with frequent sales rejections?(*)
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Are you willing to be captive (Lincoln Heritage Life Insurance Company exclusively) if you could make $75,000 your first year?(*)
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If appionted, how much training do you feel you need?(*)
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What do you see as your biggest weakness?(*)
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What do you see as your biggest strengths?(*)
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List your short-term goals.(*)
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List your long-term goals.(*)
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You're almost done! Please let us know how heard about us, including when and how you would like to be contacted.

Are you willing to drive at least one hour from your home to make sales calls?(*)

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Are you looking for a Full or Part Time Position?(*)

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Do you schedule appointments via telephone?(*)

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Are you open to following our proven system of selling, without variance?(*)

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Why should we contract you?(*)
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Tell us why we should consider contracting you

Additional Comments
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Please add any additional comments regarding your skills and or information you believe to be pertinent.

Upload your resume' (optional)
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If you are new to the C² Group, and would like your application to be reviewed more quickly, please upload your resume'.

How did you hear about us?(*)
Please tell us how you heard about the C² Group.

If an Agent referred you, please enter the agent's name, or enter NA(*)
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How should we contact you?

When would you like to be contacted?(*)
Please select a date when we should contact you.

When is the best time to contact you?(*)

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Fill Out the Form(*)
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