1. Personal Details
We need these to let you know about the status of your application.

First Name *

Last Name *

Phone *

Email *

I consent to receive communications from Remote Rebellion at the email/number provided, including promotional emails, newsletters, special offers, and product updates. "I understand I can unsubscribe at any time."

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Discovery Call Drop-Off Tracker

Last Form Submitted

2. How many years of experience do you currently have?

3. What's your current work status?

4. Where have you spent most of your working life? *

5. What's your monthly salary? (USD) *

6. What's your experience working remotely? *

7. What's actually going wrong in your remote job search right now? *

*Please provide as much info as possible - how long have you been searching, what challenges are you facing, what would you like help with specifically?

8. Who else is involved in your decision making process? *

No-one. I make my own decisions

My spouse/family member

We'd recommend looping in a spouse or family member before the call - or you're welcome to have them join us directly.

9. If you joined a programme designed to help you land your ideal remote role, when do you want to start? *

Right away

In the next 2 months

I'm in no rush, sometime in the next year

I'm just researching for now.

10. LinkedIn Profile URL *

11. Where did you hear about Remote Rebellion? *

If it seems we're a match, the next step is a discovery call with Michelle or someone from the Remote Rebellion team. We want to ensure it's the right use of time for both parties.

12. Which of these sounds most like you? *

I'm ready and willing to invest in reaching my goal of landing remote work.

If there’s a return on investment, I could find a way to make it happen, especially with a payment plan.

I'm not willing/able to invest even $200 a month