Please provide the following information:

First Name
Middle Initial
Last Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
Cell Phone
Fax Phone
E-mail
Date of Birth	Format 00/00/00

           Please identify and describe your work experience 0 being none 5 being expert:

How many years phone sales experience do you have in Advertising?	Choose 0 1 2 to 5 5 to 10 Over 10 (Political, Email Marketing, Direct Mail, Other)
How many years of Email marketing related sales experience do you have	Choose 0 1 2 3 4 5
Do you have high speed internet service?	Choose Yes No
Describe your overall level of  computer skills?	Choose 0 1 2 3 4 5
Describe your knowledge and ability with MS Outlook, Word and Access.	Choose 0 1 2 3 4 5
Describe your knowledge and ability with Front Page, Dreamweaver, HTML or ExpressionsWeb.	Choose 0 1 2 3 4 5
Describe your knowledge and ability with PhotoShop.	Choose 0 1 2 3 4 5
List only past ADVERTISING employment for the last 3 years , job description, responsibilities, annual pay and commission % paid to you (if paid commissions).
Describe any other computer, phone sales, marketing  or related skills