2018 Technician Application

Installation technician independent contractor agreement

Page 1 of 11 - General Information

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Name Name First Last
Preferred Name/What do you go by:
Email
Cell Phone Cell Phone - ### - ### ####
Phone Provider
Current Address Current Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Permanent Address Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Birthdate Birthdate / MM / DD YYYY
Shirt Size
Shoe Size
Drivers License Details
Drivers License Number
State
Expiration Date
Upload a Picture

Attach Files

This pic will be used for your badge. The picture should be taken against a white wall. Below is an example of how your picture should be aligned:
Recruited By:
Do you have a Facebook Profile?

Do you have a Facebook Profile? Yes No

We will add you to our Facebook Clear Home Tech page.
Add Facebook Profile Name here:
Banking Info
Bank Name:
Account Number:
Routing Number:
Must be 9 characters. Currently Entered: 0 characters.
* I understand if the bank information I provided is incorrect, I will not get paid