ASSOCIATION MEMBERSHIP APPLICATION



THANK YOU FOR YOUR INTEREST IN BECOMING AN
ASSOCIATE WITH THE TRINITY LIFE GROUP.
BECOMING AN ASSOCIATE WITH THE TRINITY LIFE
GROUP MAY BE THE BEST DECISION YOU HAVE MADE
IN YOUR CAREER. PLEASE TAKE THE TIME TO
COMPLETE THE FOLLOWING ASSOCIATION APPLICATION AND RETURN IT TO THE AGENT OR ASSOCIATE THAT GAVE IT TO YOU. WE WILL CONTACT YOU VERY SOON AFTER REVIEWING YOUR APPLICATION.
IF YOUR APPLICATION IS ACCEPTED, WE WILL FORWARD TO INFORMATION THAT WILL TAKE YOU TO OUR SPECIAL RECRUITING WEBSITE WHERE YOU CAN DOWNLOAD THE APPROPRIATE CONTRACTS AND FORMS NECESSARY FOR YOU IN ORDER TO GET CONTRACTED WITH OUR MANY INSURANCE & FINANCIAL SERVICES COMPANIES.

PLEASE TYPE OR NEATLY PRINT ALL REQUESTED/
REQUIRED INFORMATION.

YOUR DIRECT UPLINE ASSOCIATE AGENT (unless noted otherwise) IS: THE TRINITY LIFE GROUP

YOUR FULL NAME:

__________________________________________

YOUR SOC. SEC.#___________________________

YOUR PRESENT AGE-_______________

YOUR DATE OF BIRTH-_____________________

YOUR COMPLETE MAILING ADDRESS:

__________________________________________

YOUR COMPLETE STREET ADDRESS(if different than above):

_________________________________________

YOUR AREA CODE AND TELEPHONE NUMBER:

______________________________

YOUR AREA CODE AND FAX NUMBER:

_______________________

YOUR AREA CODE & PAGER NUMBER:

________________________

YOUR AREA CODE & CELL PHONE NUMBER:

________________________

YOUR e-mail address:

________________________

YOUR WEBSITE ADDRESS:

www.____________________

DO YOU HAVE H.S. OR G.E.D.?_________
DO YOU HAVE ANY COLLEGE EDUCATION?________
(if so how much and what was or is your
major)?___________________________________

WHERE DO YOU WORK NOW?

____________________________________________
WHAT IS YOUR TITLE AND WHAT DO YOU DO?

____________________________________________
____________________________________________

WHAT IS YOUR PRESENT GROSS MONTHLY INCOME FROM THIS JOB? $___________

DO YOU HAVE ANY ADDITIONAL EMPLOYMENT?______
WHERE ELSE DO YOU WORK?_____________________
WHAT IS YOUR TITLE AND WHAT DO YOU DO?

___________________________________________

WHAT IS YOUR GROSS MONTHLY INCOME FROM THIS
JOB? $_____________

ARE YOU MARRIED?__________ HOW MANY CHILDREN
DO YOU HAVE?______

WHAT IS THE TOTAL GROSS MONTHLY INCOME FROM THE EMPLOYMENT OF BOTH YOU AND YOUR SPOUSE?
$____________

DO YOU HAVE RELIABLE TRANSPORTATION?_______

DO YOU WANT TO WORK THIS BUSINESS FULL-TIME
OR PART-TIME?_________

<<< Not Presently Holding A License.

ARE YOU WILLING AND ABLE TO PAY THE REQUIRED
COSTS AND FEES ASSOCIATED WITH TRAINING AND
GETTING YOUR CERTIFICATIONS & LICENSE?______

Please be advised There may also be additional costs associated with membership in some of our affilated marketing organizations.

<<<Presently Holding Current Insurance Licenses

WHY ARE YOU REQUESTING ASSOCIATION WITH THE
TRINITY LIFE GROUP?
___________________________________________

WHAT INSURANCE COMPANIES ARE YOU PRESENTLY
APPOINTED OR LICENSED WITH?
____________________________________________
____________________________________________
____________________________________________

HOW LONG HAVE YOU HAD YOUR INSURANCE LICENSE?
______________

DO YOU KNOW ANY OTHER LICENSED INSURANCE
AGENTS THAT MAY BE INTERESTED IN BEING ASSOCIATED WITH THE TRINITY LIFE GROUP?
______________

<<Associate Applicants.

PLEASE PROVIDE 3 PERSONAL CHARACTER REFERENCES NOT RELATED TO YOU:

Name:__________________________________
Address________________________________
Phone Number_____________________
How Long?_______

Name:___________________________________
Address_________________________________
Phone Number___________________
How Long?_________

Name:____________________________________
Address_________________________________
Phone Number___________________
How Long?____________

YOUR SIGNATURE_____________________________
DATE________

<<<<<<>>>>>>


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