SQM Application Form
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General Information

SQM Representatives have access to exciting assignments, around the world, including: Inspections (sometimes referred to as Mystery Shopping), Market Research, and Field Merchandising. To best connect our field force with appropriate assignments, we require the following, detailed information.

Please complete the full application, by carefully following all instructions, and answering all questions. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED BY OUR AUTOMATED SYSTEM.

Your First Name:
Your Last Name:
For the field above, only use lower case or upper case letters. Never use symbols, commas or periods in this field
Preferred Name:

Street Address:
For the field above, select the appropriate state or province. If you live in a country that does not have provinces or states, then select 'No state or province' and leave the second box blank.
If your province or state is not listed, select 'Other' and then put the appropriate name in the second field
(i.e. USA, Canada, Mexico)
Postal Code/Zip:
Work Phone:
Home Phone:
Fax Number:
Mobile/ Cell Phone:
Email Address:
Re-enter your email address:
For the fields above, be sure to use proper email structure, including the "@". If the two fields are not identical, a warning prompt will appear. Both fields are mandatory.

Locations: Please list the cities and towns that are within your area and will not require any additional travel expenses.
Separate with commas.
Please enter the cities and regions in the following format - i.e.:
Toronto-ON-Canada, Atlanta-GA-USA

Please be sure to use the 2 digit short form for the province/state codes (please separate with a comma and not the return key):

How did you become familiar with SQM?
(Check all that are applicable)

Please elaborate.
Who, if anyone, referred you to SQM?
Please list other Mystery Shopping Companies you currently work for (as per SQM's legal agreement).

Personal Information
Date of Birth:
/ /
I consider myself:
My height is:
My hair colour is:
My hair length is:
If you answered other, please identify your ethnicity:
Upload Photo:

WARNING: Please do not attach an image that is larger than 10MB. If you do so, you will not be able to save and submitted your application.

Marital Status:

Demographic Information
Check the highest level of education you have obtained. *

SQM conducts various programs for our clients.These programs may require specific age groups and/or individuals from varied ethnic backgrounds. To meet the specific needs of our clients it is important that this information is available.

I Speak:

I Write:

I have:
Employment status:
Business Travel:
Personal Travel:
Annual Income:
Do you smoke:
My interests are:

I have a:
(Check all that are applicable)

If other, please explain:

Newsgroups/Forums I belong to:
Frequency of Website/Internet browsing:
How often do you dine in fast food restaurants?
How often do you dine in full service restaurants?
How often do you shop in department stores?
How often do you enter a shopping mall?

Miscellaneous Information
I have a major credit card:
Credit Card Types:

Your Occupation:

I have access to a vehicle:
Car Model:
Car Make:
Car Year:

Do you have access to the Internet at home?


Valid Insurance:
Do you have access to a computer at home?

Do you have access to the Internet on wireless device?
Are you a vegetarian?

My Computer is:

My Internet Browser is:

Version if you know

Please write a short paragraph describing your best and your worst shopping experience.

As a SQM Representative for Sensors Quality Management Inc., you are paid on a contract basis. Because of this status, there will not be an official government earning/income statement issued at tax time. If necessary, it will be your responsibility to notify your local revenue service of any income earned from your work with SQM. Furthermore, in order to get paid, a worksheet (invoice) provided by SQM must be submitted outlining the work that you completed for the outlined period.
Check that you agree to these terms: *