Application for Independent Contractor Full Name: Social Security No. Address: City: State: ZIP Code : Home Telephone: Cell Phone: Yes No Email Address : Date of Birth: Driver's License No. How is your driving record? Describe: Can you drive a stick shift? Yes No Have you ever been convicted of a felony? No Yes Availability: From: To: Please specify AM or PM. MON TUE WED THUR FRI SAT SUN Date you can start: Education: High School: College: Other: School Name & Location Years Attended Did you Graduate? Yes No Yes No Yes No Date (From/To): Employer Name & Address: Salary: Reason for Leaving: PREVIOUS EMPLOYMENT: Position: Date (From/To): Employer Name & Address: Salary: Reason for Leaving: PREVIOUS EMPLOYMENT 2: Position: Date (From/To): Employer Name & Address: Salary: Reason for Leaving: PREVIOUS EMPLOYMENT 3: Position: What (if any) career goals have you set for yourself in the future? ( i.e. what do you want to be doing in the next ten years from now?) PLEASE ANSWER THE FOLLOWING QUESTIONS OPENLY AND HONESTLY What are you looking for as an A-1 Valet associate? What do you expect from this company & it's administrative team? Since the valet of cars is a service business, it is based in part on the acquisition of tips, please expand on this statement Please express any concerns you may have with A-1 Valet Inc. A-1 Valet Inc. is an equal opportunity employer.