Staff Intake Form Fill out this form to start the ASNOA onboarding process for new hires. Affiliate Information Items marked with a asterisk are required fields. Name of Agency* State* Type of Staff* CSRProducerManager Staff Information Items marked with a asterisk are required fields. First Name* Last Name* Preferred Name Personal Street Address* City* State* Postal Code* Direct Phone* Work Email* Do you need new carrier credentials for this staff member?* YesNo Insurance License Number Resident State Please Attach a Copy of Your Domiciled State Actual License Do you want staff appointed with all PL carriers? YesNo Do you want staff appointed with all CL carriers? YesNo Are there any carrier exceptions that can be made (carriers that are rarely used or wouldn't benefit the staff member)? What states need to be authorized? *Agency must have existing access to those states. **The staff member must be personally licensed in all states requested. In order to process Progressive's appointment, we need your agency credentials: User ID: Password: PIN (If changed from default 1051):