JLH Employment Application

Employment Application Disclaimer for Independent Insurance Producers

Thank you for your interest in becoming an independent insurance producer with JLH Investment Group LLC. Please read the following disclaimer carefully before proceeding with your application.

Independent Contractor Status: By applying for this position, you acknowledge and agree that if hired, you will be engaged as an independent contractor. You will not be an employee of JLH Investment Group LLC. As an independent contractor, you will be responsible for managing your business operations, including but not limited to your work schedule, expenses, and taxes.

Licensing Requirements: This position requires that you hold a valid Life and Health insurance license in the state of South Carolina, as well as any other necessary licenses required to sell final expense insurance. You are responsible for maintaining your licenses in good standing and ensuring compliance with all state and federal regulations.

Compensation: Compensation for this role will be on a commission basis. There are no guarantees of income or sales, and commissions are earned based on the policies sold and the terms outlined in the producer agreement. As an independent contractor, you will not be eligible for employee benefits such as health insurance, retirement plans, or paid time off.

Compliance and Conduct: As an independent insurance producer, you are expected to comply with all applicable laws, regulations, and ethical standards in the insurance industry. You must also adhere to the policies and procedures of JLH Investment Group LLC and conduct yourself in a professional manner at all times.

Termination of Agreement: Either party may terminate the independent contractor agreement at any time, with or without cause, subject to the terms outlined in the agreement. Upon termination, you will no longer be authorized to represent JLH Investment Group LLC or sell its insurance products.
No Employment Relationship: This application and any subsequent engagement do not constitute an employment relationship. As an independent contractor, you will not be entitled to any employment rights or benefits from JLH Investment Group LLC, and you will not be covered under any of the company's insurance policies or workers' compensation plans.

By submitting your application, you confirm that you have read, understood, and agreed to the terms outlined in this disclaimer. If you have any questions regarding this disclaimer or the nature of the independent contractor relationship, please contact us before proceeding with your application.

JLH Investment Group LLC looks forward to potentially working with you and appreciates your understanding of these important terms.

Name:

Current Address:

Ex: 40227 Tigrone Blvd. Avon, NC 27915

Social Security Number:

Date of Birth

Date

Email

example@example.com

Best Phone Number:

Insurance License Number

Type of Insurance License:

Date available to start:

Date

Are you legally authorized to work in the United States?

YesNo

Have you ever been employed by us?

YesNo

If yes, please give dates of employment, position(s) held, and state your name while employed, if different from present name

Do you have any commitments to another employer that might affect your employment here? If yes, please explain:

Are you at least 18 years of age?

YesNo

Do you have a valid driver’s license?

YesNo

Do you hold a valid Life and Health insurance license in the state of South Carolina? If yes, please provide your license number and expiration date.

YesNo

Have you ever had an insurance license suspended or revoked?If yes, please provide details.

YesNo

Have you ever been convicted or a felony, or released from prison in the past 10 years? Note: A yes answer does not automatically disqualify you from employment since the nature of the offense, date, and type of job for which you are applying will be considered. If yes, please explain:

YesNo

Do you hold any additional insurance licenses or certifications? If yes, please specify the states and types of licenses.

g.Questions Where Job Involves Account Receivable, Handling Cash, Etc.

Have you ever been convicted, pled guilty or pled “no contest” to any criminal offense involving dishonesty or a breach of trust, including, but not limited to, theft, fraud, passing bad checks, credit card fraud, forgery, or other crime? If you were charged, but the charges were dropped or you were acquitted, answer “No”.

YesNo

Have you been charged with a crime that has not yet resulted in a plea of guilty, court trial, or a dropping of the charge? Note: A yes answer will not automatically disqualify you from employment. If yes, please explain:

During the past seven years, have you been denied a driver’s license, or convicted or a moving traffic offense, including, but not limited to, driving while intoxicated or reckless driving? If yes, please explain:

Do you have any language abilities (such as reading or speaking a foreign language) that might help you perform the job(s) for which you are applying? If yes, please explain:

Skills Area Questions

Word Processing Ability?

YesNo

Computer Experience?

YesNo

Employment History

Past Insurance Experience

Educational Data

Highest Grade Completed?

Did you Graduate?

YesNo

Degree/ Diploma/ Certificate?

Please list course of study

Additional job-related seminars, short courses, workshops, or other educational experiences:

13. Please list and describe any paid or unpaid activities, honors, experience, or training that might aid you in performing the job(s) for which you have applied, and have not been listed previously in this application. Omit any activities, honors, memberships or other items that tend to identify your race, sex, national origin, age, handicap or other personal traits.

14. Please add any additional information that you think may be relevant to a decision to hire you.

Signature and ConsentBy signing below, you certify that all information provided in this application is true and complete to the best of your knowledge. You authorize JLH Investment Group LLC to verify your references, licensing status, and employment history.SignatureDate

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