Area Representative Application

REFERENCES:

Please provide the names of at least three persons not related to you whom you have known for at least two years. If you have worked as an area representative for another exchange organization in the past, please provide at least two references from schools, host families or program directors that you have worked with.
Reference #1: *

First NameLast Name
Relationship to you:*
(i.e., friend, supervisor, pastor, co-worker)
Reference #1's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #1's Phone Number:*
Reference #1's Email:*
example@example.com
Approximately how long have you known this person?*
Reference #2:*

First NameLast Name
Relationship to you:*
(i.e., friend, supervisor, pastor, co-worker)
Reference #2's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #2's Phone Number:*
Reference #2's Email:*
example@example.com
Approximately how long have you known this person?*
Reference #3:

First NameLast Name
Relationship to you:*
(i.e., friend, supervisor, pastor, co-worker)
Reference #3's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #3's Phone Number:*
Reference #3's Email:*
example@example.com
Approximately how long have you known this person?*

I certify that the information contained in this application is true and complete to the best of my knowledge, and I understand that, if hired as an Area Representative, falsified statements on this application shall be grounds for dismissal. I authorize the investigation of all statements contained herein, and the references listed above to give you any and all information concerning my previous employment. I understand and agree that, if hired, it is for no definite period and may, regardless of the date of my compensation, be terminated without prior notice.
Please sign your name below.*

Clear
Date

MonthDayYear
Date
10810 N. Tatum Boulevard, Suite 102-845 Phoenix, AZ 85028 www.arise-usa.org

Toll-Free: 1-877-6-ARISE-6 Phone: (602) 641-9699 Email: info@arise-usa.org
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