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Position Desired *
  Advance Funeral Planning Professional
  Other, please specify
Region * (check all that apply)

 

 Illinois/Iowa Indiana/Kentucky
  Ohio Michigan
  Wisconsin North/South Carolina
  Other, please specify
Biographical Information
* First Name  
* Last Name  
* Address  
Address Line 2  
* City  
* State  
* Zip Code  
* Home Phone   Enter as 10-digit number with no punctuation
Cell Phone   Enter as 10-digit number with no punctuation
Email Address  
 * I have experience in the funeral industry  Yes  No
* I have sales experience  Yes  No
Work History - Current Position
Please provide information about your current job. You may enter up to 500 characters to describe your duties and accomplishments.
Company Name
Position Held
Duties
Accomplishments
Salary Information
Current Salary Under $20,000
  $20,000 - $35,000
  $36,000 - $40,000
  Over $50,000
Salary Desired  
I want Full Time Part Time
Education - please indicate highest achieved
High School graduate
Associate's degree
Bachelor's degree
Master's degree
Mortuary School

Other Information
Licensed Funeral Director No Yes - if yes, which state(s)
Licensed Life Insurance Broker No Yes - if yes, which state(s)
I have reliable transportation and a valid driver's license Yes No
Additional comments relevant to the position you are seeking - enter up to 2000 characters.
 

 

 

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