Srr Form PDF Details

Srr form, or srr notification, is a document that is filed when an employer wishes to terminate an employee for cause. The purpose of the srr form is to provide written notice to the employee of the termination, and to provide specific details about the reasons for the termination. By filing an srr form, employers can help protect themselves from potential legal action by terminated employees. If you are considering firing an employee, be sure to familiarize yourself with the srr form and its requirements. Failing to follow protocol can lead to costly legal battles down the road.

This basic guide will help you figure out how much time it will take you to fill out srr form, how many pages it's got, and a handful of other unique details about the PDF.

QuestionAnswer
Form NameSrr Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform s srr, regerstation rr com, srr forms, form have srr

Form Preview Example

Special Registration Review Form (SRR Form)

____________________________________________________________________________

______________________________________________________

Applicant’s Full Name (Print)

Applicant’s Social Security No.

Please complete this SRR Form if you answered “YES” to one of the QUALIFICATION INFORMATION questions in the Independent Business Application (IBA). You should complete a separate SRR Form for each “event” leading you to answer “YES”. Feel free to photocopy this SRR Form and/or attach more sheets of paper as needed to provide the requested information. Submit the completed SRR Form as soon as possible to your RVP and OSJ for review.

APPLICANT’S NOTICE

Laws in the financial services industry affect who may and may not be a member of the Primerica Field Force. Because of these laws, your IBA and this SRR Form ask you certain questions about your legal background. If you have criminal, employment, financial or legal history that is requested by the IBA, this SRR Form or other applicable forms (including insurance, securities or loan origination licensing forms), you must fully disclose that history, when requested, to be considered for and remain in the Primerica Field Force. You should take care to ensure that your disclosures are truthful, complete and accurate.

You should start this Form by reviewing the THRESHOLD questions below. If the answer is “yes” to any of the five THRESHOLD questions below, you are NOT eligible to join the Primerica Field Force and you will not need to review or complete the remainder of this form. In some instances, when the answer is “yes,” attempting to engage in financial services may constitute illegal activity punishable by incarceration, fines or regulatory sanctions. If your answer is “no” to all of the five THRESHOLD questions below, you should review and complete the remainder of this Form. When doing so, be sure to dis- close fully any requested information, particularly information relating to any felony or other crime: any charges, even if they were later dropped, dismissed or reduced; any plea of guilty or no contest/nolo contendere or any entry of a deferred adjudication (sometimes called first-offender sentencing or conditional discharges), even if later expunged; any conviction or entry of a sentence, whether probation, fine, community service or otherwise.

Primerica considers this information under a Special Registration Review process. The end result of that process may be the denial of your application to join the Primerica Field Force or your acceptance only under conditions that Primerica deems appropriate. Until Primerica’s Licensing Department notifies you in writing that you have been accepted in to the Primerica Field Force, you are not authorized to conduct any Primerica business. Also, before you can solicit for any product that requires a license or company authorization, you may not engage in that line of business until you are first notified in writing that you are authorized. Ask your RVP for further guidance. If you choose to pay your IBA fee and go forward in the licensing process, you may attend Primerica education classes and participate in field meetings and training.

By signing below, you acknowledge your understanding and agreement with the matters noted above. You also certify that the disclosures you make in your IBA and on this Form are truthful, complete and accurate.

______________________________________

______________________________________________________________________________________________

Date

Applicant (Signature)

THRESHOLD QUESTIONS

Please read each of the five questions below and answer “yes” or “no.” When we say “you” in the questions below, we mean you personally and also any organization that you owned or had a controlling ownership interest in or controlled as a principal manager. If the answer is “yes” to any of the questions, you are NOT eligible to join the Primerica Field Force.

1.

Have you EVER pled guilty or nolo contendere (“no contest”) to, or been found guilty of, a FELONY crime?

YES

NO

2.

Have you, WITHIN THE LAST 10 YEARS, pled guilty or nolo contendere (“no contest”) to, or been found guilty of, a

YES

NO

 

MISDEMEANOR crime involving: (a) a financial industry law, rule or regulation; (b) lying/dishonesty, cheating or

 

 

 

fraud, money laundering or breach of trust; or (c) burglary, or theft (in any form) of funds or securities or financial

 

 

 

instruments?

 

 

3.

Has any state regulator found that you violated any law or regulation that prohibits fraudulent, manipulative or deceptive

YES

NO

 

conduct, or are you CURRENTLY expelled, suspended, barred or prevented by the order, judgment or decree of a

 

 

 

civil court or a regulatory or administrative agency from engaging in financial or professional services, or are you under

 

 

 

investigation, sentencing or order for alleged misconduct regarding financial services, lying/dishonesty, cheating or

 

 

 

fraud, breach of trust, theft in any form, burglary, sexual misconduct or indecency, violence or threats of violence,

 

 

 

money laundering or drug dealing or distribution?

 

 

4.

Are you NOW affiliated as an employee or independent contractor with a regulator or other entity providing underwriting or

YES

NO

 

investigative services to Primerica, or are you, in any way, involved in or licensed for marketing or promoting securities or

 

 

 

investments, raising investment funds, or planning, handling or advising on the investments of others.

 

 

5.

Is there NOW pending against you any criminal court action? Include any pre-trial intervention program, deferred prosecution

YES

NO

 

program, conditional discharge program, court-ordered community service requirements, or any probation requirements.

 

 

If the answer is “yes” to any of these five questions, you do not need to review or complete the rest of this Form.

5.10

If you answered “no” to all of the THRESHOLD QUESTIONS on the front pages, please continue completing this Form by reading each question below and answering “yes” or “no.” If the answer is “yes” to any question, you must provide complete details about your answer on a separate page.

6. Have you EVER been charged with, but not convicted of, a FELONY crime? Check “yes” here even if the charges were

YES

NO

 

later dismissed, dropped, reduced, or expunged.

 

 

7. Have you EVER pled guilty or nolo contendere (“no contest”) to, or been found guilty of, a MISDEMEANOR crime

YES

NO

 

involving sexual misconduct or indecency?

 

 

8. Have you, WITHIN THE LAST 10 YEARS, been CHARGED WITH, or pled guilty or nolo contendere (“no contest”) to, or

YES

NO

 

been found guilty of, a MISDEMEANOR crime involving (1) theft (in any form) of property other than funds or securities

 

 

 

or financial instruments; (2) violence or threats of violence; or (3) drug dealing or distribution?

 

 

9. Have you EVER been the subject of any civil court or regulatory or administrative agency inquiry, action, litigation, arbitration

YES

NO

 

or order, judgment or decree involving allegations of misconduct regarding financial services, lying/dishonesty, cheating

 

 

 

or fraud, breach of trust, theft in any form, burglary, sexual misconduct or indecency, violence or threats of violence,

 

 

 

money laundering or drug dealing or distribution, or are you NOW the subject of an unresolved customer complaint

 

 

 

or regulatory proceeding?

 

 

10.

Have you EVER been expelled, suspended, barred or enjoined (prevented by court order) from engaging in a trade,

YES

NO

 

profession or government contract, or been denied a trade or professional license, or had a trade or professional license

 

 

 

revoked, suspended, cancelled, non-renewed or restricted?

 

 

11.

Has a bonding company ever denied, paid out on or revoked a bond on you?

YES

NO

12.

Are you NOW, in any way, involved in or licensed for the marketing or promotion of financial services NOT involving

YES

NO

 

securities or investments? You may be required to sign an alternative agreement based on the license conflict

 

 

 

 

 

 

 

 

13.

Have you EVER pled guilty or nolo contendere (“no contest”) to, or been found guilty of, a crime NOT specified in

YES

NO

 

questions 1, 2, 6, 7 & 8 of this SRR Form?

 

 

14.

Have you ever voluntarily resigned, been discharged or permitted to resign from any contract, position or employment,

YES

NO

 

including a military position, after allegations were made that you engaged in misconduct regarding financial services, lying/

 

 

 

dishonesty, cheating or fraud, breach of trust, theft in any form, burglary, sexual misconduct or indecency, violence

 

 

 

or threats of violence, money laundering or drug dealing or distribution?

 

 

15.

Have you, WITHIN THE LAST 10 YEARS, made a compromise with creditors or been the subject of a bankruptcy petition, or

YES

NO

 

had unsatisfied judgments or liens pending against you?

 

 

16.

Are you now, as an agent, indebted to any insurance company, general agent, manager or broker?

YES

NO

On A SEPARATE PIECE OF PAPER for each “yes” answer, please describe actions leading to the event, beginning and ending dates, and other details about your answers above. Also attach any supporting documents you have verifying the information provided. For criminal court (#s 6, 7, 8, 13) and agency mat- ters (#s 9 ,10), list the name of the crime or allegation and the Code section under which you were charged, the resolution of the charge, and the details of any sentencing, discipline or orders relating to the matter. You may wish to contact the lawyer who handled your case for details and fax a copy of this Form to the attorney to help you. For financial information (#s 11, 15, 16), please describe the event fully, its resolution or current status, and whether (and in what amount) you currently have defaulted debts or liens outstanding.

FIELD APPROVAL

RVP Certification. I have received and reviewed this completed form and any applicable documents. I have met or talked with this applicant and find the appli- cant to be credible. I have ensured that the references the applicant has made known to me through the IBA have been or will be checked and that a thorough background interview has otherwise been performed. After carefully reviewing all information available to me in this matter, I believe that the applicant is trust- worthy and of good character, will protect/promote the goodwill/reputation of Primerica and the Field Force, and is otherwise qualified to join the Primerica Field Force. I will immediately report to Primerica’s SRR Unit or Office of the General Counsel information I receive that changes my belief. I will supervise the applicant carefully in light of his/her background and any undertakings herein. I recommend that the applicant be permitted to join the Primerica Field Force.

________________________________________

___________________________________________________________

___________________________

Date

RVP Signature

RVP Solution Number

OSJ Certification. After carefully reviewing the information available to me in this matter, I believe that the applicant is trustworthy, of good character, will protect/ promote the goodwill/reputation of Primerica and the Field Force, and is otherwise qualified to join the Primerica Field Force. I believe, and will take steps to ensure, that the RVP will supervise the applicant carefully in light of the applicant’s background and any undertakings herein. I support the RVP’s recommendation.

________________________________________

___________________________________________________________

___________________________

Date

OSJ Signature

OSJ Solution Number

© 2010 Primerica / 41113 / 6.10 / 04LIC38-7

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