Please Note, use only numbers and letters when filling in any information on this form, if you use any other characters your application will not be accepted.

User Information
Please select a user name (6-20 Characters):
Please select a password (6-15 characters):		Remember passwords are case sensitive.
Repeat Password:

Personal Information
First Name:	Last Name:	Gender:
Address:			Month : Year
City:	Province:	Date of Birth:
Country:	Postal Code:
Home Phone:	Work Phone:
Fax:	Cell Phone:
Email Address:

Please answer the following questions
Do you have prior mystery shopping experience?
If so, for how long?
Types of shops performed?
Name of the person who referred you (if applicable)
What Languages are you FLUENT in?
Do you have access to a reliable vehicle?

Why do you want to become a shopper, and what skills or qualities will make you do a good job?

Please list all the towns and cities you can perform shops in

Please list all the companies you and other members of your household work for currently and have worked for in the past 2 years.

By submitting this application I hereby agree that I will not perform any mystery shops for companies that I, or any member of my household currently work for, or have worked for in the past 2 years.

Mystery Shopper Application