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| 1. List the three most important aspects of the Affiliate Program that make you interested in our opportunity. |
| B. |
| C. |
| Contact Information | |
| Name | |
| Phone | |
| Best Time To Call |
| 2. List your preferred niche/specialties that you would work with if you became an Affiliate. |
| A. |
| 3. How many years have you sold staffing services in an agency or search firm setting? |
| A. |
| 4. Do you have a non-compete agreement that is currently in affect? |
| A. |
| 5. What is a realistic start date for you if both parties agree to move forward? |
| A. |
| 6. Do you currently have an office setup in your home or away from your home? |
| A. |
| 7. Do you have the discipline and the financial resources to work independently and to survive financially while ramping up your business? |
| A. |
| 8. Please provide three references (at least two business related). We prefer only name and e-mail address but provide phone if necessary. |
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Name
E-mail
Phone A. |
| B. |
| C. |
| Cut and paste your resume below: |
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