Applicant individual background questions
If you responded yes to any of the individual background questions, please explain all in detail under separate cover and attach appropriate documents (I.e. official court records, etc.), and email to agencyappointment@markel.com.
Do you have delinquent unpaid debts exceeding, in total, $10,000? (Add together consumer debt, tax liens, loans, child support payments, alimony payments, civil judgements and other delinquent debt.)
Yes
No
With the exception of situations specific to continuing education, have you ever been the subject of an administrative proceeding regarding any professional or occupational license that resulted in disciplinary action?
Yes
No
Have you filed for, or been discharged from any bankruptcy (including personal bankruptcy), insolvency or assignment for the benefit of creditors with a filing or discharge date, whichever is later, in the last 5 years?
Yes
No
With the exception of situations specific to continuing education, has your insurance license ever been suspended or revoked by any regulatory agency or have you ever surrendered your insurance license or been fined, penalized, sanctioned or subject to any other disciplinary action by a state or federal regulatory agency, including any current investigations by a regulatory agency as a result of your activities in the business of insurance?
Yes
No
Have you ever had an insurance agency contract or any other business relationship with an insurance company terminated for any alleged misconduct?
Yes
No
Are you currently under investigation for or have ever been convicted of, plead guilty or no contest to, any misdemeanor involving dishonesty or breach of trust or any felony?
Yes
No
Are you now subject of any complaint, investigation or proceeding that could result in a yes answer to any of the previous questions?
Yes
No