Open Form WFH Form Name * First Name Last Name Email * Phone (###) ### #### How did you hear about us? Referral Social Media Are you self-motivated and disciplined? Can you get work done without having others give you motivation? * YES NO Are you confident in your abilities to work without supervision? * YES NO Will you be happy spending a lot of time alone? * YES NO Do you need face-to-face interaction, or would communication via email, phone, chat, or video conference suffice? * YES NO Is your home big enough? Is there an area that can be used for office space? * YES NO Will others in the house respect your need to be uninterrupted? * YES NO Are you licensed? * (not licensed, no worries) Life Health Not licensed Thank you! Work From Home Checklist
