Sales Representative Application

Independent contractor position. Commission-only. Please complete this application accurately — it takes about 15–20 minutes.

This is an application, not an offer.

If selected, you'll receive the Independent Contractor Agreement, Commission Plan, and Compliance Acknowledgment to review and sign. Nothing is binding until those are signed.

1. Personal Information

Tell us who you are.

Are you legally authorized to work in the United States? *
Will you require sponsorship for US work authorization? *

2. Position Information

A couple of quick context questions.

3. Sales Experience

Tell us about your background in sales.

Previous sales experience (check all that apply):

4. Work History

Your last three positions, most recent first.

Position 1 (most recent)

May we contact this supervisor?

Position 2

Position 3

5. Work Setup

This is a remote role. You'll work from your own setup.

Quiet, private workspace free of background noise *
Working laptop or desktop computer *
Reliable high-speed internet (broadband, not mobile hotspot) *
Phone or headset for extended call use *

6. Professional References

Three professional references, ideally former supervisors or sales colleagues.

Reference 1 *

Reference 2 *

Reference 3 *

7. Background & Compliance Disclosures

This industry is regulated. Please answer honestly. A “yes” answer is not automatically disqualifying — but undisclosed issues discovered later are.

Have you been convicted of a felony in the last 7 years? *

Have you ever been convicted of fraud, theft, identity crimes, or financial crimes? *

Have you ever been the subject of a regulatory investigation in insurance, financial services, telemarketing, or VSC? *

Have you ever been terminated from a sales position for compliance violations or misrepresentation? *

Are you currently working with or affiliated with a competing VSC seller, broker, or administrator? *

8. Acknowledgments

Check each box to confirm you've read and understood it.

9. Electronic Signature

By typing your full legal name below, you sign this application electronically.

Signature dated May 13, 2026.

Submitting this application does not create an engagement or obligation. Nothing is binding until a signed Independent Contractor Agreement is in place.