*Last Name
*First Name
*Address
*City
*State
*Zip Code
*Main Phone #
Alternate Phone
*E-mail Address
*Date of Birth (MM/DD/YYYY)
*Gender
Female
Male
*Marital Status
Single
Married
Divorced
*Occupation
*Industry
Evaluator Experience
Yes
No
If Yes, how many years?
0-1 Years
1-3 Years
3 or more Years
What type of internet connection do you have?
Dial Up (modem)
DSL
Cable
None, I use someone else's
To avoid a conflict of interest, please be sure to list ALL restaurants
you have been employed by.
If you do not have Microsoft Internet Explorer 5.0 or above, would you be willing to upgrade?
Yes
No
Internet Explorer Download
Please rate your computer skills and comfort level on a scale of 1 - 5.
(1 being uncomfortable and little knowledge and 5 being extremely comfortable and knowledgeable).
Scale
1
2
3
4
5
*When are you available to do evaluations?
Any Day
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Breakfast
Lunch
Dinner
Frequency (a month)
1
2
3
4
5
6
*Where are you willing to do evaluations?
Zip Code
Distance to Travel
Breakfast
Within 20 miles
Within 30 miles
Within 60 miles
Within 100 miles
Within 120 miles
Lunch
Within 20 miles
Within 30 miles
Within 60 miles
Within 100 miles
Within 120 miles
Dinner
Within 20 miles
Within 30 miles
Within 60 miles
Within 100 miles
Within 120 miles
How did you hear about EyeSpy?
If this is a referral, please list the person's name.
Please read the
Evaluator Contract Agreement
and check the box to accept.
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