~This is the Contracting & Onboarding Dept for Community Advocates, Authorized Lifeline and AHIP Certified Agents.

~We Pay You To Enroll Customers In Our Lifeline, ACP and Medicare Advantage Plans and many other essential services.

Service to others leads to great income.

Identity Information

1. First Name *

2. Last Name

3. Date of birth *

4. Social Security Number *

Contact Information

5. Phone *

6. Email *

7. Address (Include Apartment #)

8. City

9. State

10. Postal code

Lifeline Experience

~Have you worked with a lifeline or Medicare company before?

11. Lifeline Experience

12. Tell Us Something About Yourself *

Production

13. How Many Enrollments Per Day

14. How Many Enrollments Per Week

15. How Many Enrollments Per Month

Income Commitment Desired

Your income is a direct reflection of how many people you help and lives you touch!

What is your value to the community? What level of work ethic, effort, consistency, and dedication will you commit to this opportunity? This will determine your income.

Annual Income Desired: What Value Will You Bring To The Community

Work Conditions

You will not be comfortable at times.

Type "AGREE" each of the fields below to acknowledge you understand the places and conditions you will be working.

16. Work Locations & Conditions *

Tents
Shelters
Pantries
Homeless Camps
City Missions
Senior Homes
Church Events
Community Events
Office Work
Apartments
Long Days
Travel To Different Cities
Hot Weather
Cold Weather

What Level Do You Want

17. Agent Desired Level *

Bronze: Myself Only

Silver: 2-4 Teammates

Gold: 5-10 Teammates

Platinum: 10-100+ Teammates

Selfie for Badge Picture

18. Badge Picture

Badge Picture

Proof of Identity Documents

~Snap a pic of your ID and SScard and submit it in the area below.

~Be sure to get all 4 sides and all 4 corners.

19. Driver License (Un-expired)

Photo ID

20. Social Security Card

Social Security Card

21. RAD ID(skip if you don't have it)

22. Producer Number(Professional Only)

Authorization

23. Agent's Name That Referred You OR the Agency you will be working for?

24. *Authorization: By signing below, you authorize: (a) backgroundchecks.com (“BGC”) to request information about you from any public or private information source; (b) anyone to provide information about you to BGC; (c) BGC to provide our agency and its client, one or more reports based on that information; and (d) us to share those reports with others for legitimate business purposes related to your employment. BGC may investigate your education, work history, professional licenses and credentials, references, address history, social security number validity, right to work, criminal record, lawsuits, driving record, credit history, and any other information with public or private information sources. You acknowledge that a fax, image, or copy of this authorization is as valid as the original. You make this authorization to be valid for as long as you are an applicant or employee with us. The Consumer Financial Protection Bureau’s “Summary of Your Rights under the Fair Credit Reporting Act” is attached to this authorization. If you are a New York applicant, a copy of New York’s law on the use of criminal records is attached. By signing below, you acknowledge receipt of these documents. *

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