Independent Contractor Questionnaire "*" Required Fields.   Personal Information First Name:* Last Name:* Address:* City:* State:* Choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Zipcode:* Phone Number:* Fax Number: Cellular Number: Email Address:* Have you posted your profile on Narms?   Yes   No   Work Experience Provide the Name, Address, and dates of service of all companies for which you are currently or have most recently worked for. But please do not provide any information you have a duty to keep confidential.  First Company Information: Company Name: Address: Date of Service:  Second Company Information: Company Name: Address: Date of Service:   Experience How many years of merchandising work do you have?* None   1-3 Years   3-5 Years   More than 5 years Check all the merchandising experience you have: Resets (using a plan-o-gram) Basic Merchandising (placement of product, fill ins, straightening) Product Demonstrations Inventory: Counts, returns Clinics/Trainings Visual Displays Fixture Installation How many years of Retail Experience do you have? None   1-3 Years   3-5 Years   More than 5 years Do you have sales experience? No   Yes IF so, what type and how long? What type of store? (check all that apply) Dept. Stores   Belks   Boscovs   Dillards   Macys   Neiman Marcus Sporting Goods Stores   Champs   Dicks Sporting Goods   Modells   Sports Authority        Other Mass Market   Best Buy   Costco   Kohls   Target   Walmart Pharmacy/Other   CVS   Ekcerd   Walgreens   Albertsons   Current Experience I am currently working as: Independent Contractor Employee I am not currently working If you are currently working, how many hours can you devote to additional projects from other companies? Per Week:   1-5   5-10   10-20   Over 20 For other merchandising work you have done, how have you submitted store visit information? (check all that apply) Web IVR Handheld Fax Mail Other List the cities you go to or will go to as a merchandiser. (separate each name with a comma) List the malls you go to or will go to as a merchandiser. (separate each name with a comma) Describe the equipment you own:* Computer Do you have 24 hour access?   Yes   No Digital Camera Do you have experience downloading and emailing jpeg files?   Yes   No Projects often require digital photographs to show stock levels and project work scopes. Are you willing to use your digital camera and submit photo verification for projects?   Yes   No Internet Access Do you have reliable 24 hour access   Yes   No Microsoft Office with Word, Excel, etc. Do you have the ability to download, open, alter and email an Excel file? Yes   No Do you have the ability to download, open, alter and email a Word file? Yes   No Email Access Do you have your own personal email address?   Yes   No Handheld/PDA Cell Phone Will you accept text messages in relation to work projects? (Your number will not be given out to the text server unless you authorize by clicking yes.) Yes   No Fax Machine Copier   Education Select the highest level of education: Highschool   College Degree   Technical Degree Bachelors Degree   Masters Degree Do you hold a professional license? Yes   No Do you have a business license? Yes   No Describe the training you have received in your specialty. School or classes attended specific to training:   REQUIREMENTS Please provide up to three references that we may contact. First Reference Full Name* Phone Number* Email Address* Explain your relationship to this person* Second Reference Full Name Phone Number Email Address Explain your relationship to this person Third Reference Full Name Phone Number Email Address Explain your relationship to this person Are you 18 years of age or older?* Yes   No Do you have reliable, insured transportation?* Yes   No If placed on a project are you willing to provide documentation for proof of current vehicle liability insurance, as required?* Yes   No Do you have secure space in which to hold signage, brochures or other items if sent to you for use in store visits?* Yes   No Projects offered to contractors can vary from month to month, along with retail locations, due to fluctuating needs. You can accept or reject additional work projects. Do you have any concerns about the flexible nature of the business?* Particular scope of service projects will be explained if you are selected for a project. All service visits require signing in with security or customer service desk vendor logs, and contacting store personnel upon the start of your visit for security purposes. Will you abide by this requirement for each visit, at each store location?* Yes   No Explain:   Other When confronted with an in-store situation that needs immediate attention what actions have you taken to rectify the problem? Explain: In addition to the work and education experience you have listed, please describe what motivates you to do this type of work? I acknowledge these responses to be true and accurate. By filling in my full legal name in this box I append my signature to this form.* ©2010 Best Service Merchandising, Inc.

©2010 Best Service Merchandising, Inc.