Impact Marketing

Mystery Shopper Application

Red Bold fields are required.

Personal Information
First Name:
Middle Initial:
Last Name:
Address:
City:
State:
Zip:
Phone:
Cell Phone:
Email:	(youremail@yourdomain.com)
How did you hear about us?	www.Impact-Mrkt.com Newspaper Referral Other
Referral:
Current Employment
What is your current employment status?	Full Time Part Time Unemployed Retired Self-employed Other
Employer:
Responsibilities:
Are you currently looking for full time work?	Yes No
Are you an active realtor?	Yes No
Monthly Salary Requirement:
Availability
Shops take place weekdays between the hours of 10am-6pm. Shoppers need to be available for the entire day to maximize the number of assignments given.
Check the days you are available:	Monday Tuesday Wednesday Thursday Friday
Is your schedule flexible?	Yes No
Travel is required with this position.
What is your travel availability? (Check all that apply)	Willing to travel within your state Willing to travel outside your state Overnight stay Airplane travel
Profile
Year, Make and Model of car:
Have you ever purchased a home?	Yes No
If yes, was it new construction?	Yes No
Please check the scenario that best matches your status:	Single Only: I do not have a partner to pose as my spouse. Couple occasionally: I have a partner who can occasionally shop with me. Couple always: I have a partner who will always shop with me. Single/Couple Combo: My partner and I can both shop as singles or together as a couple.
Equipment and Training
Equipment is provided at no charge.
Rate your comfort level with working with electronic equipment:	Uncomfortable Slightly Comfortable Comfortable Very Comfortable
Training is provided at no fee. Depending on experience, shoppers may be required to complete a formal training program followed by training in the field in order to gain the experience to become a paid shopper. All training sessions are an investment of your time. I have read and agree to the training procedure and commitment needed.
Miscellaneous
Have you ever been convicted of a felony? Yes No
I authorize Impact Marketing to verify the information provided on this form as to my employment and references and to do a criminal background check. Yes No