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McGehee Cruise & Vacation, Inc. Cruise and Vacation Package Sales Independent Contractor’s Data Form Authorization for Background Information and Release of Liability Notice: This Data Form is Void after 30 days. To be considered for a contract after that time you must submit a new form.
Name______________________________________________ (Last) (First) (Middle) Social Security No ________________________________ Address_______________________________________ Referred by____________________ City______________________ State___________ Zip____________ Your Phone number(s) _______________________ Today’s date__/__/__ Are you legally eligible to work in the USA? Yes ☐ No ☐ (Any offer of a contract is conditioned upon your satisfying Federal verification requirements.) If contracted, do you have a reliable means of transportation to get to appointments? Yes ☐ No ☐ List all your experiences, skills and other qualifications that are relevant to cruise and vacation package sales _________________________________________________________________________________________________ List three group cruise prospects you plan to develop during your first year: ________________________________________ _________________________________________________________________________________________________ Please list cruises you have taken. _______________________________________________________________________ Please list places you have traveled internationally ___________________________________________________________ Please circle the following items that you already have: Computer, Windows 2000pro or XPpro, internet access, second telephone line, desk, chair, printer, fax machine, cell phone, pager, voice mail. Education completed: High School 1 2 3 4 College 1 2 3 4 5 6 Degree? Have you ever received a 1099 form? Yes ☐ No ☐ Have you ever paid quarterly taxes? Yes ☐ No ☐ Sales positions or other business experience:
Employer _________________________________Address ________________________________________________ Dates From_________ to_________ Supervisor __________________________________Use as Reference? Yes ☐ No ☐ Your duties_________________ Approximate yearly earnings $________ Reason for leaving ________________________ Employer _________________________________Address ________________________________________________ Dates From _________to_________ Supervisor __________________________________Use as Reference? Yes ☐ No ☐ Your duties__________________ Approximate yearly earnings $________Reason for leaving________________________ Employer _________________________________Address ________________________________________________ Dates From _________to_________ Supervisor __________________________________Use as Reference? Yes ☐ No ☐ Your duties ___________________Approximate yearly earnings $________Reason for leaving _______________________ Other references (no relatives or former employers) 1. Name ___________________________Address/Phone ______________________________________Years known __ 2. Name ___________________________Address/Phone ______________________________________Years known __ 3. Name ___________________________Address/Phone ______________________________________Years known __ I, , hereby authorize and instruct any person, school, college, university, business, company, corporation, employer, physician, clinic, hospital, law enforcement agency, or other governmental agency to disclose any information concerning my background to McGehee Cruise & Vacation, Inc., or its agents upon presentation of a photocopy of this Authorization and Release. I hereby waive any privilege that may exist with respect to such information. In return for their providing such information, pursuant to this Authorization and Release, I hereby release all of the above-described persons and entities from all liability in connection with these disclosures. Signed ________________________________Dated ______________________Witness__________________________ |