STAMP N PLUS SCRAP N

P.O. BOX 47 CHIPPEWA FALLS, WI. 54729 (715)271-1873

WWW.POWDEREDCHALK.COM    WWW.STAMPAFFAIR.COM

INDEPENDENT INSTRUCTOR APPLICATION

Full Name: ___________________________________Social Security No:_____________________

Shipping Address: (No P.O. Box)______________________________________________________

City: ________________________________________State: ___________________Zip: _________

Home phone:(__)__________________ Work phone:(__)__________________ e-mail:__________

Birth date:______________  Tax Rate:____

Have you ever been a Home Party Instructor before?_____________________________________

If yes, which companies? ____________________________________________________________

Type of products sold?______________________________________________________________

List Hobbies, skills or training:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

List three references: Name              Address                Phone

1.________________________________________________________________________________

2.________________________________________________________________________________

3.________________________________________________________________________________

Current or most recent job information:

Company Name: ________________________________________Title:_______________________

Company Address: ______________________________________ Phone No: (___)______________

Job Description: ____________________________________________________________________

Recruiter  Name: ________________________________________Recruiter No:_______

Address: _______________________________________________Phone No: (___)______________

City: _____________________________________________State: ________________ Zip: _______

I certify that the facts in this application are true. I have read the Instructor Agreement and understand and will follow all the policies and procedures to

 become an Instructor.

Signature: _________________________ Date: _________________

FOR OFFICE USE ONLY

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Application Approved: ______________________________Date: ____________By: __________

Instructor No: __________ Comments: _______________________________________________

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