New Account Representative Program Nomination Form
Program Location To Attend:
Candidate's Email Address:
Sponsoring Agency Information
Your Sales Field Representative:
Contact Email Address:
General Information About Your Candidate
How long has your candidate been employed at your agency?
How long has your candidate been in the CSR/Account Rep Role?
Please describe candidate's current job responsibilities:
Is your candidate licensed to sell insurance?
Please list any prior insurance training your candidate has had:
Does your candidate have prior experience working with The Cincinnati Insurance Companies?
Please describe your candidate's prior insurance experience, if none, please state "none":
Who is your candidate's mentor within your agency? This is a person who has an active interest in the candidate's development. Please provide us with some information about the mentor.
Mentor's Position in Agency:
Mentors's Email Address:
Is there any additional information about your candidate you feel is important for us to know?