IC Hosting Program Overview Travel Leaders Independent Advisor Program | Page 6
Independent Contractor - Information Worksheet
FULL LEGAL NAME
BUSINESS NAME
(if different from above)
DESIRED START DATE
SSN OR FEDERAL ID NUMBER
DATE OF BIRTH
TRAVEL INDUSTRY
BACKGROUND NEW TO
INDUSTRY
o NEW TO INDUSTRY
o EXPERIENCED; NEW TO TRAVEL LEADERS
o EXPERIENCED; WITH TRAVEL LEADERS
YEARS IN TRAVEL INDUSTRY: ______________________________________
CHECKS PAYABLE TO
(Business or Individual)
BUSINESS ADDRESS
BUSINESS PHONE
EMAIL
HOME ADDRESS
HOME PHONE
OTHER PHONE
EMERGENCY CONTACT
PERSONAL REFERENCES (2):
NAME
ADDRESS
PHONE
RELATIONSHIP
When completed please return to Ted Blank: [email protected]. Thank you!