C-Chex - Job Application Mystery Shopper

Contact	P.O. Box 42 Avon, New York 14414 585-243-2660

Mystery Shopper Job Application

Name:

Date:

Street Address :

City: State: Zip:

Your Date of Birth:

School(s) attended/degree(s) earned:

Dates Attended:

Work Experience:

Company Name:	Address:
Dates of Employment:	Contact Person: Contact Phone Number:
Company Name:	Address:
Dates of Employment:	Contact Person: Contact Phone Number:

Your Phone Number:

Your Cell Number:

Your E-mail Address:

Do You Have Access to a Fax Machine?
Yes No

Do You Have a computer?
Yes No

Do You Have a printer?
Yes No

Valid Drivers License?
Yes No

Any Convictions on Your License?
Yes No

Do You Have a Vehicle?
Yes No

What Kind of Vehicle Do You Own?

Is Your Vehicle In Good Working Condition?
Yes No

Vehicle Insurance Company:

What Interested You in This Position?

Is there anything else you'd like to tell us about yourself and why you should be considered for this position?