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Instructions: the purpose of this pre-screener application is to get truthful answers that provide Black Business Works preliminary information it needs to consider you as a member.  Please complete all portions of the applicaion fully and accurately.  Due to the number of prescreener applications received, we will only contact those candidates selected to continue to the next phase in the application process.

*Represents fields are required
PERSONAL INFORMATION
*User Name    
*Password (Password must contain at least 6 characters.)  
*Confirm Password    
*Last name *First Name  Middle Initial
*Street Address    
Appartment Unit          
* State *Select your city * Zip Code
* Date Of Birth * Sex Male  Female * Race
*E-mail Address    
BBW Member Referral        
Referral Last name First Name  *Phone --
* Referral Email        
PROFESSIONAL INFORMATION
* Industry/ Business type    
* Business profile image    
*Business Name / Employer * Date of employment
Website  
*Business Address      
* State *Select your city  
* Zip code *Phone - - 
*Title      
Certification(s)/ License(s)      
* Brief job description (list supervisory/ Administrative skills)    
   
* Professional organization affiliations.      
  Name City Office head  
1.  
2.  
* Why are you interested in becoming a member of Black Business Works Inc.?    
     
* What areas in your business or profession do you feel you need help with?    
     
* In your field of expertise what do you feel you can bring to the BBW organization?    
     
Basic free account membership business profile (Limited functionality).
Monthly membership business profile ($50.00)
Yearly membership business profile ($480.00)
Have you ever been convicted of a crime? (A conviction will not automatically disqualify you from being chosen. Factors such as job relations, seriousness and nature of violation will be taken into account.) We value and respect your privacy. You can rest assured that any information you provide will be kept confidential and will be used for the sole purpose of communicating with you, and will not be sold or given to any third party.
Yes
No
* I accept privacy policy of Black Business Works