Tester Application- CSA San Diego

11. Have you ever been convicted of any felonies, crimes of fraud of perjury?

NoYes

If yes, please explain:

12. Do you agree not to participate in the unlawful manufacture, distribution, dispensing, possession or use of illegal controlled substances while working for CSA?

NoYes

13. Have you or your significant other ever held or currently hold a real estate license and/or work in the real estate profession?

NoYes

14. Do you have a disability?

NoYes

15. If yes, what is your disability?

16. What assistive devices do you use if any?

17. Is someone assisting you with this form?

NoYes

18.Should we contact that person to set up testing?

NoYes

19.Person's Name:

Name of Person Assisting you

Person's Phone Number:

Phone number of person assisting you.

20.Are you married?

NoYes

21. If yes, your spouse's name

22. Is your spouse interested in becoming a tester?

NoYes

23. Do you have children?

NoYes

If yes, how many?

24. Are you presently employed?

NoYes

25. Please list most current employer

26. Position

27. Length of Employment

28. Work Address

29.Are you a full-time student?

NoYes

30. If yes, what school do you attend?

31. Major

32. Anticipated graduation date

Date

33. Please check the highest level of education you have completed:

34. Have you ever engaged in "testing" or "auditing" for discrimination before this?

NoYes

35. if yes, to what extent?

SeldomPeriodicallyExtensively

36. Which organization administered the testing?

37.If you have never "tested" or "audited" before, have you ever known about such activity?

NoYes

38.Generally, what is the best time for you to do testing?

MorningAfternoonEvening

39. How much advance notice do you need prior to performing a test?

40. Are there any days which you cannot perform a test?

41.Do you have access to a car?

NoYes

42. Which types of testing are you willing to perform?

RentalSalesLending

43. List of Professions you feel comfortable performing, e.g., teacher, mechanic, nurse, sales representative:

Please add additional professions you are comfortable performing

44. Professions you do not feel comfortable performing, e.g., accountant, network analysis, lawyer

Please add additional professions you are not comfortable performing

45. Would you have any personal/moral objections if you are provided with a fictional biography that you are to use as background information and/or identification (ex. employment, reason for moving, etc.) When presenting yourself as a home-seeker or apartment seeker?

NoYes

46. In case of emergency, notify

47. Name

Phone Number

Please enter a valid phone number.

49. Address

"I certify that all the information submitted by me on this application is true and complete and I am signing under the penalty of perjury. And I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and if I am hired as an independent contractor (tester), my position may be terminated at any time.

In consideration of my being hired as an independent contractor (tester), I agree to conform to the company's rules and regulations, and I agree that my position and compensation can be terminated, with or without cause, and with or without notice,at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for my being hired asan independent contractor (tester), for any specific period, or to make any agreement contrary to the foregoing."

Name

First NameLast Name

Signature

Date

CONFIDENTIAL," This Form Belongs To CSA San Diego County, And Any Unauthorized Use Is Not Permitted

Tester Application

Certification

Disability

Home and Family Characteristics

Employment Data

Education

Experience as a Tester

Availability as a Tester