RSG Assurance Recruitment Application Form

RSG Connect /// Assurance

INDEPENDENT AUTHORIZED OUTREACH AGENT APPLICATION:
Personal Information:
Recruiter Code
Enter The Recruiter Code in the Email With Your Application Link
Full Legal Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Which State Will You Be Marketing LifeLine Services In?
*Select ONLY One Option; This Will Be Your Primary Market.
Phone Number

Area CodePhone Number
E-mail
Your Primary Contact Email
Alternate Email
Birth Date

MonthDayYear
Social Security Number
RAD ID #
If You Do Not Have a RAD ID, You Must Obtain One Prion To Completing Your Application
RAD ID Email
The Email You Used When You Registered With USAC
Bank Account Number
* Required for Payroll
Routing Number
Required for Payroll
Position Applying For
Do You Have LifeLine Experience?
Do You Have Reliable Transportation?
Do You Have An Android Tablet?
Do You Have Event Locations?
Additional Information
Optional: Briefly Provide Additional Information About Your Qualifications Or Experience
Photo ID

Upload a File
Please Upload A Picture Of Your Photo ID Cancelof
HeadShot Photo

Upload a File
Please Upload A HeadShot Photo Of Yourself Cancelof
Completed W9 Form

Upload a File

Cancelof
Send Application:
By clicking the SUBMIT button, I understand that I am applying to provide services as an Independent Contractor, and that as such, I am responsible for all taxes and fees resulting from the compensation I receive for services provided.

Inventory and Property provided by RSG and/or its Clients shall remain the property of Rhino Sales Group, LLC. RSG reserves the right to “Charge Back” the Responsible Contractor for items not returned, or accounted for while in the possession of the contractor. Charge Backs for damaged, lost or stolen property will be deducted from pending and future commissions payable to the Contractor by RSG.
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RSG Connect /// Assurance

Personal Information:

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