Mystery Shopper Application Today's Date* Date Format: MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Telephone*Mobile Phone*Email Address* Enter Email Confirm Email Age*(We would like this information in order to be able to be able to determine if you will fit the client's requirements.)Are you?*(We need this information in order to make the required assignments.)CaucasianAfrican-AmericanHispanicAsianOtherIf "Other," please specify.*Are you currently employed?*(Does NOT include mystery shopping.)YesNoLooking for a jobWhere are you employed and/or what is your job function?*(We will not contact your employer. )Are you a Silver Certified Shopper?*YesNoAre you a Gold Certified Shopper?*YesNoPlease provide your Gold Certification number.*How many months or years have you been mystery shopping REGULARLY?*Have never mystery shoppedDo not mystery shop regularly, but have mystery shopped in the pastJust started mystery shopping. Less than 1 month1 to 3 months4 to 6 months7 to 9 months10-12 months13-18 months19-23 months2-3 years3-5 yearsMore than 5 yearsAre you available to travel ...*Within 25 milesWithin 50 milesNot sure where or need more informationDo you own or have 24/7 access to ...*(Check all that apply.) Computer/laptop iPad or its equivalent (Do NOT check if you only own a smart phone, no matter how large.) Other If "Other," please specify.*Do you have 24/7 internet access IN your home?*YesNoSometimes / IntermittentIs your internet access?* Cable DSL WiFi Dial-up (Check all that apply.) Do you currently have equipment to perform video shops?*YesNoDo you have experience performing video shops?*YesNoPlease submit a writing sample of at least 100 words. You will not be considered without a writing sample. (This is a rolling box with plenty of room.)*PhoneThis field is for validation purposes and should be left unchanged. Medical Mystery Shopping Our Approach In the News | News | Press Releases In Print | Print Articles | News & Notes Client Feedback Case Studies About Us | Our Team Contact Us | About Our Services | Mystery Shopper Application Blog Devon Hill Associates LLC 1535 El Paso Real La Jolla, CA 92037 Tel: 1-858-456-7800 Contact: Barbara Gerber ©2022 Devon Hill Associates