Service Connections : Shopper Application

Please complete the following information. When you are finished, click "Continue" to move on to the next step of the application process: the shopper test. An asterisk (*) indicates a required field.

System Username:*	(Unique, 5-20 chars, no spaces)
Enter Password:*
Reenter Password:*	Strength:
Email Address:*
First Name:*
Last Name:*
Address:*
City:*
State:*
ZIP Code:*
Phone (cell):*	(Format: 999-999-9999)
Phone (home):	(Format: 999-999-9999)
Phone (work):	(Format: 999-999-9999)
Birthdate:*	(Format: 09/30/2009)
Employment Status:*
Occupation:*
Current Employer:*

Are you a current or previous mystery shopper for Service Connections?*

How did you hear about Service Connections?

Please provide more information about who or what referred you (friend's name, program, etc.):

Mystery shopping experience:*

Please list Mystery shopping certifications:

Our clients frequently request specific target market research. The following information is required to enable proper selection for our shopping programs.

Gender:*
Race:*
Marital Status:*

Please list the cities you are available to shop (To select multiple cities, hold down control/command and click each city): *


SERVICE CONNECTIONS, INC. 225 North Delaware St., Indianapolis, IN 46204 1-800-582-8281 MYSTERY SHOPPER AGREEMENT I agree to provide mystery shopping and other services ("Work") to Service Connections, Inc. ("SCI") on all of the terms and conditions stated in this Mystery Shopper Agreement ("Agreement") when requested and as instructed by SCI. This Agreement shall govern all Work I perform, and may be terminated at any time by either SCI or myself, without cause, by giving written notice to the other party. I agree to carry out the Work in a professional and courteous manner, to follow exactly all policies, instructions and directions from SCI, and to provide truthful and accurate information to SCI and its employees at all times. I agree to be listed in the SCI database as an available mystery shopper. I understand that I may or may not be selected to perform Work, and no promise of Work is being made by SCI. SCI may remove me from its database at any time in its sole discretion. In the event that I am assigned to perform Work, I may accept or decline any assignment. When I accept an assignment, SCI will provide instructions for the Work at the beginning of each project, and will advise me of the contract payment amount for the Work and any expense items relating to the Work to be reimbursed to me. By commencing performance of the Work assignment, I agree to the instructions, contract payment amount, reimbursement amounts, and all other terms and conditions of the Work. I will send SCI a statement for the agreed contract payment amount and reimbursements upon the completion of each Work assignment. SCI shall not be required to pay for any Work, reimbursements or other charges for which a statement is not delivered to SCI within thirty days after the amounts become due. A Work assignment shall not be considered to be completed until all receipts, paperwork and reports requested by SCI have been completed and delivered to SCI, and all SCI Property has been returned to SCI in good working order. Once the Work has been completed, and a statement is received by SCI, payment of the amounts set out in the instructions for the Work will be made by SCI within sixty (60) days after receipt of the statement by SCI. SERVICE CONNECTIONS, INC. MYSTERY SHOPPER AGREEMENT ADDITIONAL TERMS AND CONDITIONS Shopper shall be deemed to be an independent contractor of SCI for all purposes, and shall not be deemed to be an employee of SCI, SCI's customer(s) or others for any purpose. Amounts to be paid to Shopper shall not be considered to be "Wages" for any purpose. Shopper shall be responsible for reporting all income and paying taxes on payments from SCI. Shopper will execute all appropriate tax and other forms upon request by SCI. Shopper shall not assign this Agreement. Secrecy concerning the Work is essential. All of the Work and all writings and communications concerning the Work shall be considered confidential, proprietary and Trade Secret information. Shopper shall, at all times, both before and after the termination of this Agreement, safeguard and maintain the secrecy of the identity of SCI's clients, and the secrecy of all contact information, forms, instructions, questions, reports, data, passwords, e-mails, documents and all other information sent, received and/or generated at any time relating to the Work and/or SCI ("Confidential Information"). All of the Confidential Information is and shall remain property of SCI at all times, and Shopper hereby assigns to SCI all rights to the Confidential Information. Shopper agrees never to disclose any of the Confidential Information other than to SCI, and to cease all use of and destroy all copies and embodiments of the Confidential Information within thirty (30) days, or upon completion of each Work assignment, whichever first occurs. Integrity concerning the Work is essential. Shopper shall perform the Work honestly and shall not omit any information or give any false or misleading information to SCI. Shopper shall not perform any similar work for others with respect to any client of SCI. Shopper shall not contact any Client of SCI for any purpose other than as required for the performance of the Work. Shopper shall not solicit or accept any payment or thing of value from any employee or client of SCI, or from others relating to any client of SCI. Shopper shall notify the President of SCI immediately in writing at the address shown on the reverse of this Agreement in the event that Shopper learns of any inappropriate, false, misleading, or dishonest conduct or event relating to the Work, SCI and/or any of its shoppers, employees and/or clients, stating when it occurred, the person(s) involved, and the exact nature thereof. SCI may rely upon the absence of such written notification by Shopper as a representation by Shopper that no such conduct or event has occurred. Equipment and other items ("SCI Property") may be provided to Shopper in connection with the Work. Shopper agrees to be responsible for and to return all SCI Property to SCI at the conclusion of the Work in good working order. In the event that SCI Property is not so returned, Shopper shall be responsible for the costs of repair or replacement of the SCI Property. I agree to all of the above. I have carefully read and also agree to all of the Additional Terms and Conditions, the limitations upon the liability of SCI and the Waiver of Trial by Jury in this Agreement. Each of the Additional Terms and Conditions of this Agreement is a part of the consideration for this Agreement and shall be a part of this Agreement for all purposes.
	Check here if you do NOT want your contact information shared with other reputable mystery shopping companies seeking shoppers in your area of coverage. (Only name and e-mail will be shared.)
Accept Agreement?:*	Yes No
Legal Name to confirm agreement:*

If you have never or previously shopped for Service Connections, pressing the Continue button will bring up a Test Survey. You must fill out this Test Survey in order to complete the shopper application process.

SSL Certificate Authority

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