Application

Defy Lifeline Agent Application Form

Please complete the form below to apply for a position with us.
How did you hear about us?*
Were you referred by a Master Agent or Street Agent? If yes, please enter their name below:
Do you have a RAD ID? If so please provide it below, if not leave blank.
You can find your RAD ID in your email or USAC website. If you need a RAD sign up at https://www.usac.org/lifeline/rad/
Full Name*

First NameMiddle NameLast Name
Email Address*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any experience in Sales or with the Lifeline Program? If so, how much?*

None0-2 years3-5 years6-10 years10+ years
What experience do you have with direct sales or customer outreach?*
Give us 1- 2 sentences.
Have you worked with government assistance programs like Lifeline before?*

YesNo
How comfortable are you with using mobile devices and explaining technology to customers?*

Very ComfortableSomewhat ComfortableNot Very ComfortableNot comfortable at all
When I hear a "no" from a prospect I . . .*

Feel that I have failed to do my job properlyTake it as a personal failureLet it bother me more than I shouldUse the criticism to improve and move forward
Are you comfortable working independently and meeting daily or weekly goals?*

YesNoMaybe
Do you have reliable transportation to reach different sales locations?*

YesNo
Are you available to work weekends or travel locally for outreach events?*

YesNoMaybe
Which of the following represents what motivates you the most?*

Receiving praiseMaking moneyLearning new thingsSolving problemsMaking a difference for our clients
How do you build trust with customers quickly in a face-to-face setting?*
What motivates you to succeed in a sales-driven environment?*
Why do you want to work with Defy Mobile and help connect people through the Lifeline Program?*
RESUME (OPTIONAL)

Cancelof
Should be Empty:

Defy Lifeline Agent Application Form