Name
*
First Name
Last Name
Position / Title
*
Are you an administrator?
Yes
No
Employment Start Date
*
/
Month
/
Day
Year
Date
Dialpad Number
*
Please enter a valid phone number.
Fax Number
*
Please enter a valid phone number.
Email
*
example@example.com
Home Office
*
BEAT AIDS Headquarters (208 W Euclid, 78212)
San Antonio Care Center - Five Points (230 E Fredericksburg Rd., 78212)
Your Choice Clinic
Newly Empowered Women (618 Hudson St., 78202)
Back
Next
Agreement
I understand that I am required to wear my BEAT AIDS ID at all times during
working hours including in meetings and trainings
AS PART OF MY UNIFORM
. (Outreach to client’s home is the exception)
I understand that if at any time my ID is lost or stolen, I must report this to my immediate supervisor.
I understand lost or stolen ID cards will be replace at my own expense in order to meet BEAT AIDS dress code policies.
I understand that a $5.00 fee will be requested of me if ID is lost or stolen.
Signature
*
Upload Your Photo (no selfies)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: