Farmers Insurance Group

Welcome to District 59

The Bay Area Recruiting and Training Center
Application Form

Last Name First Name
Address
City Zip Code
Home Phone Bus. Phone
E-mail address
How did you hear about us?
Newspaper CareerBuilders.com
Phone contact HotJobs.com
Referral BayAreaJobFinder.com
Monster.com Other
Four year college degree? Yes No
If yes, what is your degree? When?
Length of time in your community?
Are you presently employed? Yes No
Have you ever been licensed to sell insurance? Yes No
Do you have other selling experience? Yes No
Do you have supervisory experience or have you ever owned your own business? Yes No
If "Yes", explain
In light of this being a business opportunity, we need to ask you some financial related questions to determine if you meet some of our basic financial requirements:
Do you have any liens placed against you? Yes No
Have you declared bankruptcy in the last 7 years? Yes No
If so, what type? Chapter 7 Chapter 11 Chapter 13
If so, when was it discharged?
Have you ever had any judgments placed against you? Yes No
Are you a U.S. citizen or permanent U.S. resident? Yes No
Any motor vehicle accidents or traffic citations in the past 5 years? Yes No
If "Yes", explain
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