Safe Passage Interest Form
Safe Passage Employment Interest Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Employment Type
Safe Passenger (Ensure safety of youth to/ from school to community)
After School Support Worker (Provide support to schools and after school programming)
After school Facilitator ( Facilitate groups and lessons to youth)
Target Area ( Each employee will be assigned to a target area)
Minnesota Avenue area
Good hope Road area
Anacostia area
Availability
Morning ( during route to school)
Afternoon (during route from school)
Both morning and afternoon
After school programming only
Do you have any experience with the following (Check all that apply)
Mediation
Conflict Resolution
Community Engagement/ Activities
Community Canvas/ Community Watch
NONE OF THE ABOVE
Do you have any of the following charges (Check all that apply) ?
Sexual Assault/ Offenses
Child Molestation
Physical Abuse (including minors)
NONE OF THE ABOVE
Are you fully vaccinated?
Yes
No
Were you referred by one of the following (Check one only)?
GROWING UP LLC
Inner City Collaborative Community Development Corporation
Tumani DC
Submit
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