Ver-A-Fast Questionnaire

Questionnaire

Please answer as many questions as you can. The more information that you accurately provide Ver-A-Fast the faster this questionnaire can be processed. Ignore questions that do not apply to you. You must be at least 18 years of age to submit your information.

Ver-A-Fast never charges fees or asks for upfront money to participate in our verification programs. No one is authorized by Ver-A-Fast to accept any compensation directly from an applicant or verifier for a referral or any type of information or training.

We respect your privacy. All information submitted is used for contact purposes only and is never distributed outside of our organization.

Questionnaire Note: Items with a red *asterisk are required


    *First name     :   *Middle Initial : 
    *Last name      : 
    *Phone number   :()-

    *How did you hear about us?  Please list ID# if obtained from a flyer:

Your Address Details:

Ver-A-Fast is not currently recruiting independent contractors in the following states: CA, CT, AK, HI, WI, NY, MA, WA, NV & OR.

    *Street        :
    *City & County :
    *State         :
    *Zip           :

Your Phone Service Details:

    Unlimited Local Service? Yes No
    Touch Tone?              Yes No
    Call Waiting?            Yes No
    Privacy Manager?         Yes No

Any service or device that prevents your number being displayed on others
Caller ID? Yes No

Your Education Details:

    *Highest Grade Completed
                     College
      If GED, date acquired: Year

Are you fluent in Spanish? Yes No

    Briefly summarize any special training or skills you have in the
    box below :

Are you presently attending any continuing education courses? Yes No

    *Have you ever provided services to Ver-A-Fast or on behalf of Ver-A-Fast
    under this or any other name at any time?                     Yes No
    If YES, when?

Approximate number of hours for which you wish to contract services:
Per Week

Fill in Times Available Per Day: (Example: Mon 5pm-9pm)
Mon Tue Wed Thu Fri

Sat Sun

Date you can start

*Have you ever been convicted of a felony? Yes No
If Yes, in what: State County Year

Describe offense

Your Employment Details:

    Are you employed now? Yes No
    If YES,               Full-time Part-time
    Number of hours weekly
    Present Employer     :
    Type of Work         :
    Address, Street      :
    City                 :
    State                :
    Zip                  :
    Specific hours       :
    Phone number         :()-
    How long employed    :
    Can we contact your current employer? Yes No
    If YES, contact name :
    If NO, reason:

Your Prior Work Experience:

(List most recent first)

1. Company    :
   From       :
   To         :
   Position   :
   Do you still provide services? Yes No
   If NOT, reason:


2. Company     :
   From        :
   To          :
   Position    :
   Do you still provide services? Yes No
   If NOT, reason:

Working From Home:

    1. Have you ever worked from home before? Yes No
    If YES, what type of work?

2. Briefly summarize activities outside the home you are involved in.

    3. Briefly summarize how you would organize your evening hours to accomplish
    this work with your other obligations.

    4. Have you discussed this opportunity with your family? Yes No
    If YES, elaborate:

Your Home PC Details:

Level of expertise on the computer
Your typing speed (WPM)?

    *Do you have an IBM compatible computer?    Yes No
    Total Memory (RAM) in megabytes (MB)?

    Approx. Hard Drive space available?
    Your computer has which Processor?

    Check Devices installed:
    CD-ROM Color Monitor(SVGA or better)
    Cable/DSL Modem (No less than 28800 baud)

    *Your Operating System is?

    Your modem is connected to comm?

    Phone number of your modem?              ()-
    Do you have call waiting on the modem line? Yes No
    *Cable/DSL provider?
    *Do you have a working printer?             Yes No
    Do you have an external fax machine?        Yes No
    Who is your Internet Provider?
    *What is your email address?

Please check through all the information that you have supplied on this form and ensure that all the details you have entered are correct.

Due to a high number of responses, questionnaires with all required fields completed will be given first priority.

There is a small risk that a third party could view your supplied information during transit to Ver-A-Fast. Ver-A-Fast contact number is (440) 331-9962

Please note that by choosing the "I agree" option and clicking the SUBMIT button below you:

1) Certify that the facts contained in this questionnaire are true and complete to the best of your knowledge.

2) Authorize investigation of all statements contained herein and the references listed above to give any and all information concerning previous employment and any pertinent information they may have, personal or otherwise, and release all parties from liability for any damage that may result from furnishing same.

3) Any claim or lawsuit related to your independent contractor service with Ver-A-Fast Corporation must be filed no more than six (6) months after the date of the action that is the subject of the claim or lawsuit. You waive any statute of limitations to the contrary.

I agreeI do not agree

Click once on the SUBMIT button to complete your Ver-A-Fast questionnaire.

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