Regional Operator Application

Your Name/ Address
Last Name (required)
First
Middle Initial

Address
Years at this address
City
State
ZIP
Your cell phone

Company Information
Name of Business
Your Title
Address
City
State
ZIP
Business phone
Legal Name Under Which the Business Operates
CorporationPartnershipProprietorship
Name of Company Principal Responsible for Business Transactions

Employment History
1)
Employer
Job Title
Address
Your Supervisor/Phone
City
State
ZIP
Salary
Start Date
End Date
Reason for Leaving

2)
Employer
Job Title
Address
Your Supervisor/Phone
City
State
ZIP
Salary
Start Date
End Date
Reason for Leaving

3)
Employer
Job Title
Address
Your Supervisor/Phone
City
State
ZIP
Salary
Start Date
End Date
Reason for Leaving

Business/Trade References
Name of Reference
Their Title
Company name
Address
Their Phone Number
City
State
ZIP

Name of Reference
Their Title
Company name
Address
Their Phone Number
City
State
ZIP

Education
Degree
Major
Institution
Year

Professional Certifications, Awards, Recognition
Certifications, Awards, Recognitions
Institution
Year

Other Information

How did you hear about us?
Have you even been convicted of a felony?
Have you or anyone on your partnership team filed for bankruptcy?
Have you or anyone on your partnership team been involved in a lawsuit?
Do we have your permission to run a background check for credit, security, and education?

Geographic Region Preference
What geographic region did you want to set up a business? Why that region?

Goals/Objectives for Your Regional Operator Area
Please describe your business goals/objectives for the geographic region you want.

Sales Strategy
Please describe your sales strategy and how you plan to achieve the sales quota required for your region.