LCM Agent Application

LCM Agent Application

Thank you for your interest in being an LCM Agent. Please fill out the form below to see if you qualify.
Personal Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
Please enter a valid phone number.
Email*
example@example.com
Referred By
Employment Desired
Position Applying For*

Customer Service / SalesManagement - Requires Experience
Do you have previous experience?*

YesNo
Date You Can Start*

MonthDayYear
Date
Are You Employed Now?*

YesNo
May we inquire of your present employer?*

YesNo
Please provide name of current employer, position, name of manager, and manager's number.*
Ever applied to this company before?*

YesNo
Where did you apply before?*
When did you apply before?*
Work Schedules/Shifts*

Full Time - Monday through Friday (Weekends Optional): 9:00am - 7:00pm
What State Are You Applying For*
What City or Area*
What Type of Position are You Applying For*

Independent PositonOffice Position

Education History

	Name & Location of School	Years Attended	Did You Graduate?	Subjects Studied
High School
College

Former Employers (List below last two employers, starting with last one first)

	From (Month & Year)	To (Month & Year)	Company Name	Position	Reason for Leaving
Employer 1
Employer 2

Former Employers Contact Information

	Name	Title	Phone Number	Email
Employer 1 Contact Person
Employer 2 Contact Person

Do you have customer service/sales experience?*

YesNo
Do you have management experience?*

YesNo
If yes to above, please provide details*
What is your longest position held and where?*
Do you have a working smartphone or tablet with cellular service?*

YesNo
If hired today, would you be able to start within 3-5 business days?*

YesNo
Are you currently able to travel to our headquarters in Wilmington, DE Monday to Friday? Or are you willing to relocate to be able to travel to our headquarters Monday to Friday, if you are hired?*

YesNo
How Did You Hear About Us?*

Indeed.comSignReferralOther

Provide at Least Two Personal References (not family members)

Personal Information