DiamondCard Processing Corporation

Independent Sales Consultant Personal Information
Name: _______________________________________
Email: _______________________________________
Telephone: _______________________________________
Address: _______________________________________
City: _______________________________________
State: _______________________________________
Zip: _______________________________________
Fax: _______________________________________
Driver's License #: _______________________________________
State: _______________________________________
Social Security #: _______________________________________
Date of Birth: _______________________________________

Please list your last ten years of work history.

1.

From (mm/yy): _______________________________________
To (mm/yy): _______________________________________
Company Name: _______________________________________
Address: _______________________________________
City: _______________________________________
State: _______________________________________
Zip: _______________________________________
Supervisor: _______________________________________
Annual Salary: _______________________________________
I left because: _______________________________________

Describe your position and responsibilities at this company:

__________________________________________________________

__________________________________________________________

__________________________________________________________

2.

From (mm/yy): _______________________________________
To (mm/yy): _______________________________________
Company Name: _______________________________________
Address: _______________________________________
City: _______________________________________
State: _______________________________________
Zip: _______________________________________
Supervisor: _______________________________________
Annual Salary: _______________________________________
I left because: _______________________________________

Describe your position and responsibilities at this company:

__________________________________________________________

__________________________________________________________

__________________________________________________________

3.

From (mm/yy): _______________________________________
To (mm/yy): _______________________________________
Company Name: _______________________________________
Address: _______________________________________
City: _______________________________________
State: _______________________________________
Zip: _______________________________________
Supervisor: _______________________________________
Annual Salary: _______________________________________
I left because: _______________________________________

Describe your position and responsibilities at this company:

__________________________________________________________

__________________________________________________________

__________________________________________________________

Important Note:

A Background Clearance is required for all independent contractor and commission only salespersons before work may begin with DiamondCard Processing Corporation. A copy of your Driver's License and Social Security Card must be submitted via fax (909) 989-4693. Thank you for your interest!