VSA Apply Full name State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia 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 Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Phone Email Number of years licensed Number of states licensed in List of states Are you confident in your ability to communicate effectively over the phone and email? Yes No Available hours M-F? Are you able to call on various weekends for a few hours? Yes No Have you been convicted of a crime? Yes No Have you had a bankruptcy or have any current bad debts or unpaid chargebacks? Yes No Fluent in any other language besides English? Yes No Go to speedtest.net and click “begin test”. Input your download and upload speeds below: Do you have a reliable computer? Yes No What are the top 3 companies & products you've sold recently and why?(ie SBLI term because..., Banner GUL because... and Foresters final expense because...) Previous Employment. Where have you worked in your last 2 jobs, (a) for how long and (b) what did you do? If you have a Linkedin profile, please enter the URL here: Submit Application *** After submitting your online application for our VSA Program, our sales manager will call you to ask some follow up questions. We’ll reach out within 2 business days.