Become a WOW Trainer

Thank you for your interest in working with WOW ASPEN, LLC (the “Company”). The Company engages independent contractors like you in particular disciplines on an as-needed basis. Your completion of this application does not guarantee that the Company will engage your services and is subject to the Terms and Conditions set forth below. Please complete the entire application as completely and accurately as possible so the Company can match you to the best potential opportunities.

 

 

WOW Trainer Application

1. Applicant/Independent Contractor Information
Applicant Full Name *
Applicant Full Name
Home Street Address *
Home Street Address
Mobile Phone *
Mobile Phone
Daytime / Evening Phone if different from mobile
Daytime / Evening Phone if different from mobile
2. Emergency Contact
Emergency Contact Name
Emergency Contact Name
Who should be contacted if you are involved in an emergency?
Emergency Contact's Address
Emergency Contact's Address
Emergency Contact's Phone
Emergency Contact's Phone
3. Provider Services Offered For:
$
4. If approved as an independent contractor, when would you be available to begin? *
4. If approved as an independent contractor, when would you be available to begin?
Yes, I was convicted of _________ on _________ (date) in _________ (city), ____ (state)
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO AN INDEPENDENT CONTRACTOR AGREEMENT UNLESS RELEVANT TO THE TYPE OF WORK.
8. Applicant Skills
For the skills that you have, enter the number of years of experience.
Enter Years (Number) of Experience
Enter Years of Experience (Number)
9. Work Experience
Supervisor Name
Supervisor Name
Employer Address
Employer Address
Start Date
Start Date
End Date
End Date
Supervisor Name
Supervisor Name
Employer Address
Employer Address
Start Date
Start Date
End Date
End Date
Supervisor Name
Supervisor Name
Employer Address
Employer Address
Start Date
Start Date
End Date
End Date
10. Applicant’s Education and Training
11. References
List two non-relatives who would be willing to provide a reference for you.
Name
Name
Address
Address
Phone
Phone
Name
Name
Address
Address
Phone
Phone
13. Do you have Liability Insurance? *
14. Is your CPR/AED Certification current: *
16. Do you have your own personal equipment for house calls? *
**CLICK SUBMIT BUTTON BELOW **