Application and Referral Agreement

Name *

First Name

Last Name

Phone Number *

(###)

###

####

Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you legally authorized to work in the U.S.? *

Yes

No

Do you have a valid driver’s license? *

Yes

No

Do you own or have access to reliable transportation? *

Yes

No

Background and Screening *

* The Contractor agrees to provide proof of a valid background check within the past 12 months. * The Contractor may be required to provide updated background checks annually to remain eligible for referrals.

Yes

Independent Status *

* The Contractor is an independent business and is not an employee, partner, or agent of the Referral Service. * The Contractor is solely responsible for their own business operations, including but not limited to: Taxes and insurance; Tools, supplies, and equipment; Setting rates, schedules, and methods of work; Compliance with all applicable laws and regulations

Yes

Referral Agreement *

I have read and agree to the referral agreement found here. I have printed and saved a copy for my records: https://www.bookproglow.com/agreement

Yes

Electronic Signature Consent *

By typing my name below, I agree that this typed name will serve as my electronic signature. I understand that my electronic signature has the same legal effect as a handwritten signature

Yes

Date *

MM

DD

YYYY