Candidate Registration

First Name: Last Name: Email Address: Confirm Email: Password: Confirm Password: City: 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 RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Zip Code: Phone:
Please select your registrations and licenses: Series 24 Series 65 Life, Accident and Health Series 27/28 Series 66 Property & Casualty Series 3 Series 7 Certified Life Underwriter Series 4 Series 8 Certified Public Accountant Series 55 Series 9/10 Certified Financial Planner Series 6 Variable Annuities Chartered Financial Analyst Series 63 Variable Life Chartered Mutual Fund Counselor
How does your product mix break down (approximately):   % Mutual Funds % Life Insurance   % Fixed Income % Fee-based asset management   % Equities % Variable Annuities & Variable Life   % Options % Other
Years registered or licensed?	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20+
U-4 Clean?	Yes No N/A
If NO, How Many Occurrences? 0 1 2 3 4 5 6 7 8 9 10+      When was your last Occurrence? No Occurrences Within a Year Over 1 Year Ago Over 2 Years Ago Over 3 Years Ago Over 4 Years Ago Over 5 Years Ago Over 6 Years Ago Over 7 Years Ago Over 8 Years Ago Over 9 Years Ago Over 10 Years Ago Over 11 Years Ago Over 12 Years Ago Over 13 Years Ago Over 14 Years Ago Over 15 Years Ago Over 16 Years Ago Over 17 Years Ago Over 18 Years Ago Over 19 Years Ago Over 20 Years Ago
How soon would you like to make a career change?	Immediately 1 to 3 Months 3 to 6 months 6 months to 1 year
What is your yearly gross production or commissions?	Less than $50k $50k to $100k $100k to $150k $150k to $200k $200k to $250k $250k to $300k $300k to $350k $350k to $400k $400k to $500k $500k to $750k $750k to $1m $1m to $2m $2m+
What is your total Assets Under Management?	Less Than $2m $2m to $5m $5m to $10m $10m to $15m $15m to $20m $20m to $25m $25m to $35m $35m to $50m $50m to $75m $75m to $100m $100m to $150m $150m to $250m $250m+ N/A
What percentage of your Assets Under Management are transferable?	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
How many clients do you manage?	1-50 51-100 101-500 501-1000 1000-2000 2000+
What type of firm would you like to work for? No preference Fund National Bank Insurance Company Regional Credit Union Internet Wirehouse
Please select the type of firm you are currently licensed with:	Regional Firm Wirehouse Insurance Broker/Dealer Independent Bank Broker/Dealer Not Currently Licensed
How long at your current firm?	Less Than a Year 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10+ Years