Client Onboarding Form

Client full name

Client cell *

Client email *

How many Admins do you have (enter n/a if you will be the contact person for your new hire) ? *

Select an option

Enter n/a if you will be the contact person for your new hire)

Admin's name

The contact person's info we will provide to your new hire. (enter n/a if you will be the contact person for your new hire)

Admin's email

The contact person's info we will provide to your new hire. (enter n/a if you will be the contact person for your new hire)

Admin's cell

Admin's name 2

Admin's email 2

Admin's cell 2

Admin's name 3

Admin's email 3

Admin's cell 3

Admin's name 4

Admin's email 4

Admin's cell 4

Admin's name 5

Admin's email 5

Admin's cell 5

How many Managers do you have (enter n/a if you will be the contact person for your new hire) ? *

Select an option

Manager's name

Manager's email

Manager's phone

Manager's name 2

Manager's email 2

Manager's phone 2

Manager's name 3

Manager's email 3

Manager's phone 3

Manager's name 4

Manager's email 4

Manager's phone 4

Manager's name 5

Manager's email 5

Manager's phone 5

Your Agency Name *

Your SGA *

Your Agency Division *

Select an option

Your Agency Website

Which course do you require your new hires be enrolled in? *

Life

Life & Health

Life & Health w/ Code & Ethics

LLQP

Who is the Health Care provider your agency uses for benefits? *

Agency training: duration and hours required of new hires. *

What state or province are you located in ?

Please check all the states/provinces that you can hire in. The more you provide, the better we can meet your quota *

AL

AK

AZ

AR

CA

CO

CT

DC

DE

FL

GA

HI

ID

IL

IN

IA

KS

KY

LA

ME

MD

MA

MI

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PA

RI

SC

SD

TN

TX

UT

VT

VA

WA

WV

WI

WY

AB

BC

MB

NB

NL

NS

ON

PE

SK

Please check the priority states/provinces that you prefer hiring in *

AL

AK

AZ

AR

CA

CO

CT

DC

DE

FL

GA

HI

ID

IL

IN

IA

KS

KY

LA

ME

MD

MA

MI

MN

MS

MO

MT

NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK

OR

PA

RI

SC

SD

TN

TX

UT

VT

VA

WA

WV

WI

WY

AB

BC

MB

NB

NL

NS

ON

PE

SK

How many hires per week would you like to begin with? (5 hires per week is the minumum to start) *