Biographic Information      
           
Last:
 		First:
 		Middle:
 		     

Address:
 		City:
 		State:
 		ZIP:
 		     

Secure Shipping Address (if different than home address):
 		City:
 		State:
 		ZIP:
 		     

Home Phone:
 		Mobile Phone:
 		     

Email:
 		Alternate Email:
 		Do you have a PayPal e-mail address? If so please enter the address below:
    

Date of Birth:		 What is your gender?
Group box Male Female
      

Emergency Contact:		 Emergency Contact Home Phone: Emergency Mobile Phone:
      

Emergency Contact Address:		 City:
 State:
 ZIP:
      

Relationship:		      
       
How did you learn about SmartRevenue?
    
     
What is your primary means of transportation?
 Distance you are willing to travel:
  
       
Education      
       
Highest Level of Education Completed:
 		     
Colleges and/or Universities Attended Major Advisor              Dates Attended Degree Obtained
Work Experience      
       

Employer 1:

      
Company:    
Supervisor (name & title):    
Supervisor Phone:    
Job:    
Address:    
City, State, ZIP:    
Dates Worked:    
Briefly Describe your role, responsibility and history with the company:  
Reason for leaving:  
May we contact your supervisor?:
Group box Yes No
      
       

Employer 2:

      
Company:    
Supervisor (name & title):    
Supervisor Phone:    
Job:    
Address:    
City, State, ZIP:    
Dates Worked:    
Briefly Describe your role, responsibility and history with the company:  
Reason for leaving:  
May we contact your supervisor?:
Group box Yes No
      
       

Software Skills

      
  Please rate your proficiency on a scale of 1 to 5, select No Proficiency if you do not have experience with the software package.    
Microsoft Word    
Microsoft Excel    
Microsoft PowerPoint    
SPSS    
Computer Accessibility      


Do you own a computer?

    


What system/OS is your computer?

    

Do you have internet access at your place of residence?

    
References      

Professional Reference

      
Name    
Phone    
Email    
Dates Known    
Relationship    

Personal Reference

      
Name    
Phone    
Email    
Dates known    
Relationship    
       
Market Research Experience      
  Checkmark all areas that you have experience in:    
Focus Groups      
In-store interviewing      
Telemarketing      
On-line Market Research      
Survey Administration      
Promotions/Product Trials      
Sales      
       
Research Experience      
       
Have you ever worked for SmartRevenue
      
       
Including SR, please mark any quantitative research experience:
Surveys Structured Interviews Conjoint analysis Cluster analysis Factor analysis
 
Including SR, please mark any qualitative research experience:
Focus Groups Participant Observation Open-ended Interviews Event analysis
Ethnographic Decision Models Causal flow charts Native or folk taxonomies  
 
What languages (other than English) are you familiar with? Proficient? (specify if proficiency is verbal or written or both)    
Spanish    
Other Language (specify)
 		   
Other Language (specify)
 		   
Other Language (specify)
 		   
     
Please explain your main research interests and main sub-culture (group) that you have worked with (maximum 250 words)  
 
 
 
Finally please provide us with a short 2-3 paragraph biography (maximum 250 words)  
 
 
 
       
SmartRevenue is an equal opportunity corporation and does not discriminate against or permit harassment of consultants, employees or applicants for employment on the basis of race, color, sex, gender, pregnancy, religion, creed, national origin, age, alienage and citizenship, status as a perceived or actual victim of domestic violence, disability, marital status, sexual orientation, military status, partnership status, genetic predisposition or carrier status, arrest record, or any other legally protected status.



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