VFG Recruitment Application Form

Valerie Financial Group

P O Box 1747

Thomson, GA, 30824

info@valeriefinancialgroup.com

www.valeriefinancialgroup.com

(762) 242-0294
Employment Application

Independent Insurance Broker
Personal Information:
Full Name*

First NameMiddle NameLast Name
Enter your NPN*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Birth Date*

MonthDayYear
YesNo
Employment Desired:
Position Applying For*
.
Date You Can Start*

MonthDayYear
Date
Salary Desired ($)
YesNo
Education:
High School*
Name of High School Attended
Number of Years Attended
YesNo
College
Name of College/University Attended
Number of Years Attended
Area of Study/Degree
YesNo
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Area of Study/Degree
YesNo
Skills/Qualifications:

What qualifies you to partner with Valerie Financial Group? Ex: What are your goals, mission, or purpose?
Skills*
List any relevant skills
Qualifications*
List any relevant certifications or qualifications
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Current Salary ($)
Reason for Leaving?
Start Date

MonthDayYear
Date
YesNo
References:

List at least one reference for character purposes.
Reference 1*
Name of Reference
Relationship*
Years Acquainted*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Reference 3
Name of Reference
Relationship
Years Acquainted
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cover Letter & Resume (Optional):
Cover Letter

Cancelof
Resume*

Cancelof
Send Application:
Date

MonthDayYear
Date
Signature
Should be Empty:

Employment Application

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

References:

Cover Letter & Resume (Optional):

Send Application: