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New Agent Assessment
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Your Name
First
Last
Phone
Email
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
How did you find us?
I keep losing clients to Orr & Associates!
Orr & Associates Agent
Personal Referral
Search Engine
Social Media
Other
Who referred you to Orr & Associates?
First
Last
Education Completed
High School
Technical School
Special Training
College
Post Graduate
Employment Status
Not Employed
Student
Employed Part-time
Employed Full-time
Self-employed
How long have you been in your present occupation?
Not Applicable
Less than 1 year
1 – 3 years
3-5 years
5+ years
Do you have experience working on an entirely commission based income?
Yes
No
Years of Sales Experience
None
Less than 1
1 – 3 years
3 – 5 years
5+ years
Years of Insurance Experience
None
Less than 1
1 – 3 years
3 – 5 years
5+ years
What about this opportunity enticed you?
What interests you about the insurance industry?
What are you looking for in a new role?
What do you think you can achieve in this role that you can't at other companies?
What do you consider to be your greatest strengths and weaknesses?
Which one of our company values do you identify with the most and why?
What does your ideal work environment look like?
What's one of the most valuable lessons you've learned in your career? How would you apply it in this role?
What's the biggest mistake you've made in your career and how did you handle it?
Among the people you've worked with, who do you admire and why?
Looking back on the last three years of your career, what’s the highlight?
Do you work best independently or alongside others?
Independently
With Others
Are you able to stay focused on your goals?
Yes
No
Do you have the financial resources to start a business?
Yes
No
Do you have a support system of positive people in your life?
Yes
No
Are you comfortable generating your own leads for new business opportunities?
Yes
No
Do you have experience setting your own work schedule?
Yes
No
Do you provide yourself with enough time for continued education?
Yes
No
Do you provide yourself with enough time for personal fitness?
Yes
No
Do you provide yourself with enough time for leisure and recreation?
Yes
No
Do you have any bankruptcies, tax liens or judgements against you that might prevent you from getting an insurance license?
Yes
No
Do you have a criminal record that might prevent you from getting an insurance license?
Yes
No
Are you looking for a full-time or part-time role?
Yes
No
Do you have a transition plan to start a new career?
Yes
No
Do you need help developing a transition plan or improving your current plan?
Yes
No
When are you planning to start a new role?
MM slash DD slash YYYY
