Box 5 - Credential & W-9 info
Full name as appears on your State Issued ID
*
Prefix
First Name
Middle Name
Last Name
Suffix
Date of Birth
*
/
Month
/
Day
Year
Date
Gender
*
Male
Female
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Email
*
example@example.com
If you do not have a current staff jacket, please indicate your jacket size.
Mens - Small
Mens - Medium
Mens - Large
Mens - X Large
Mens - XX Large
Womens - Small
Womens - Medium
Womens- Large
Womens - X Large
Womens - XX Large
Please upload a passport quality & format photo.
This means:
White Background
No Hats & Sunglasses
Top of shoulders and above
*This can be taken with your cell phone as long as it meets the requirements.
Photo Upload
Browse Files
Photo must be under 1000 KB
Cancel
of
Please upload your completed W-9 form
Download a W-9 to complete. Click the ">>" to download
Upload your completed W-9
Browse Files
Only the first page needs to be uploaded
Cancel
of
Waiver and Hold Harmless
The following Terms & Conditions are required by the insurance companies and by our partner's legal council.
ANSWER ALL QUESTIONS TRUTHFULLY AND COMPLETELY. Candidates may be rejected if they have intentionally made a false statement of a material fact, or have practiced or attempted to practice deception or fraud
*
Yes
No
Have you ever been arrested?
Have you ever been convicted of a crime involving violence or threat of violence?
Have you ever been convicted of a crime involving criminal activity in drugs or alcoholic beverages?
Have you ever been convicted of a sex-related crime?
Have you been or are you currently on a sex offenders registry?
Have you ever been convicted of any other crime except a minor traffic violation? (Includes Traffic Crimes)
If you answered yes to any of these questions, please provide details
*
Submit
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