QSI Specialists -- Mystery Shopper Application

Employment History (most recent first)

Start month & year	End month & year	Name & address of employer	Position	Reason for leaving	May we contact them?
*	*	*	*	*	Yes
					Yes
					Yes
					Yes
					Yes

If you have Mystery Shopping experience, please list company name and dates of employment.

Company Name	City & State	Employed from (Month/Year)	Employed to (Month/Year)

Are you over 18?* Yes No

Are you over 20?* Yes No

Are you over 21?* Yes No

Do you have military base access? Yes No

Do you have airport access? Yes No

Do you have a driver's license? Yes No

If yes, do you have a motorcycle endorsement on your license? Yes No

Do you have a current NV PILB Work Card? Y/N Yes No

If yes, Work Card number?

If yes, Work Card expiration date?

Are you authorized to work in the United States?* Yes No

Are you MSPA certified? Gold Silver None

MSPA Certification Number

Do you speak a foreign language? Yes No

If yes, what languages?

Do you own a time share? Yes No

If yes, what brand of time share do you own?

Please list any special skills, education or training you have had that would help you be a mystery shopper:

Do you agree to appear at any labor board hearings or other employment review proceedings that may result from your observations and reports as a mystery shopping associate for QSI Specialists?* Yes No

Who do we contact in case of an emergency?

Name	Street Address	City	State	Phone Number	Alt Phone Number	Relationship

Education History

	Name, City, State	Years Attended	Did you graduate?	Subjects studied
High School			Yes No
College			Yes No
Trade, Business, or Postgrad school			Yes No
Other			Yes No

If you live outside the state of Nevada, please complete the following:

How many times a year do you visit Nevada?

What cities do you visit in Nevada?

How long is your average trip to Nevada?

Do you rent a car when you visit Nevada? Yes No

By typing my name below, I certify that the information contained in this application for employment is true and complete to the best of my knowledge and I understand that if I am employed, falsified statements may be grounds for dismissal.

Please watch your email for correspondence from QSI Specialists. You may need to check your junk or spam mail box. We typically respond within 3 business days of receiving a completed application. You should receive an automatic response with a link to the required mystery shop sample. Please complete the assignment and submit in a timely manner so we can review your complete application and writing skills.