"Thank you for your interest in becoming a Channel Watch Agent !PLEASE READ THE FOLLOWING BEFORE COMPLETING THIS APPLICATION: The only purpose of this questionnaire is to obtain information that will allow Channel Watch to retain the services of qualified independent contractors to participate in its programs. This is not an application for employment with Channel Watch nor a guarantee that any future services will be contracted with applicant. To be considered for the program, interested persons must fill out this application correctly. Failure to do so will result in immediate disqualification. Any falsification or omission of information on this questionnaire may also result in disqualification from the program. All information is confidential and will be used only by Channel Watch, its clients and affiliates. Channel Watch does not discriminate on the basis of age, race, gender, national origin, religion, sexual orientation, political ideology or presence of disability. (*Required fields) "
Are you already a Field Rep for Channel Watch? Click here to find out!  
Profile Information

* required field
Your name

*First name


*Last name

Social Security #

Organization Name: 
Gender:  DOB: (MM/DD/YYYY) *E-mail Address Alternate E-mail Address
Male Female
*Please re-enter your email address for verification

Mailing address  
*Address Address 2 *City *State *Zip Code
*Phone number Work number Cellphone
()- Ext. ()- Ext. ()-
Alternate number Fax number
()- Ext. ()-
Shipping address, if different from above (Must NOT be a P.O. Box)
Address Address 2 City State Zip Code

* I am interested in
Mystery Shopping Have Done Interested In
 Telephone mystery shopping   
 Web-based mystery shopping   
 Web-based panel   
 In-person mystery shopping   
 In-store interviews   
 Product pick-up   
 Telephone interviewing   
 In-person customer interviews/intercepts   
 Retail Observations   
Merchandising Have Done Interested In

* General availability to perform jobs
(check all that apply)

before 12 pm
12 pm - 5 pm
after 5 pm
All week

Highest Education Level

Are you currently employed?
 Yes   No
If yes, please indicate your occupation:

Work Experience
Computer Hardware
Computer Software
Food and Beverage
Household Products
Other Consumer Electronics
Other Consumer Products
Secret Shopper

What type of Internet browser do you use?

Search engine or link you used to find us

* Have you ever worked as a mystery shopper before?
 Yes   No If yes, please tell us about your experience:

* Have you ever worked as a merchandiser before?
 Yes   No If yes, please tell us about your experience:

* Have you ever worked as a telephone interviewer before?
 Yes   No If yes, please tell us about your experience:

* How many miles are you willing to travel?  

* Do you own an digital camera?
 Yes    No    

Are you able to print from your computer?
 Yes   No

* Please write a short paragraph describing yourself in terms of your personality, strengths etc, and your background.

Certificate License Number
 MSPA Bronze
 MSPA Gold
 MSPA Silver

Languages besides English spoken

Please read the following: