Contractor Registration Form
Choosing the very best!
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list your skills below.
*
Please list all your experience
*
Please list all your certifications below.
Do you have any security clearances?
Yes
No
Do you have proof of your work insurance
Yes
No
Are you licenses for the job I am hiring you to do?
Yes
No
Please provide a copy of your insurance, bonding, or license.
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Reference Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Business/Company Name
Position
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Business/Company Name
Position
I agree to conduct myself with integrity, honesty, and transparency. I also agree to provide detailed photo and video reports of my work to Marsha Kerr Talley on WhatsApp.
Yes
No
Please provide a copy of your photo ID or driver's license.
*
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Signature
*
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