Register as Mystery Shoppe

Name*

Title

First

Last

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Birth Date*

Age

Home Phone

Cell Phone

Date of birth is important so we can send you on appropriate assignments

Are you Bi Lingual? *

Yes

No

If yes, Language?

Email*

Select Ethnic*

Yes

No

If yes, for whom?

How long.? (Years/Months_

Have you ever worked in a restaurant or tavern? *

Yes

No

If yes, describe all duties and positions held.

List special training or equipment used

Any Special Skills

If Other explain:

Establishments I would feel uncomfortable working at

When agents are given an assignment, Count On Us strives to maintain the agent’s anonymity. This is accomplished, in part, by matching the agent with the demographics of the establishment’s clientele.

For example, if an agent was older assigned a shop where the clientele is in their twenties, the agent would stand out, and would likely “blow his/her cover.” A similar situation would occur if an agent were assigned a shop where the clientele is of a different ethnic background or gender, then that of the agent. It is for this reason only that we request that applicant answer all the above questions.

•Write a paragraph or two about a recent dining experience.

I understand that all information supplied or gathered by me is to be held in the strictest of confidentiality, and I will not discuss my assignment with anyone. I also understand that all work performed by me is covert in nature, and I am not to reveal my identity under any circumstances. I understand that I am not to approach any employee or owner of the business where I have been assigned to do surveillance work and divulge my identity. If my identity is revealed, I understand that I may not be reimbursed for the assignment.

☐ By checking this box, I certify that the facts contained in this application is true and complete to the best of my knowledge.