Area Representative Application

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Area Representative Application

OCEAN - Organization for Cultural Exchange Among Nations
Name:*

First NameMiddle NameLast Name
Date of Birth:*

MonthDayYear
Gender:*

FemaleMale
Physical Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Is your physical address the same as your mailing address?*

YesNo
Please provide your mailing address:*

Street Address

Street Address Line 2

CityState

Zip Code
Do you have a home phone number?*

YesNo
Home Phone:*
Do you have a cell phone?*

YesNo
Cell Phone Number:*
May we contact you by text?*

YesNo
Do you have a fax?*

YesNo
Fax Number*
E-mail Address:*
example@example.com
What is the best time to contact you?*
Emergency Contact Person:*

First NameLast Name
Relationship to You:*
(Spouse, sibling, friend, etc.)
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number:*
Email*
example@example.com
Are you a U.S. citizen?*

YesNo
If not, are you an alien authorized to work in the United States?*

YesNo
If so, please explain:*

EDUCATION:

	Name of School	Location of School	# of Years Attended	Did you graduate?	Subject/Field Studied
High School
College or University
Vocational School
Other

Have you done any special studies or research work?*

YesNo
If so, please describe?*
Please list any special skills that you possess that might be useful in this job?
Have you ever been convicted of a felony or misdemeanor?*

YesNo
Please explain:*
Have you ever had contact with Child Protective Services in the past?*

YesNo
Please explain:*
Do you currently work or volunteer for any of the local schools in a coaching, teaching or administrative capacity?*

YesNo
Please explain:*
Are you currently employed?*

YesNo
Please provide the following information:
Name of Employer:*
Job Title:*
Duties:*
Name of Supervisor:*

First NameLast Name
Supervisor's Phone Number:*
Supervisor's E-mail:
example@example.com
FORMER EMPLOYERS (Please list your last 3 employers below, if applicable.)
Former Employer #1:
Job Title:
Dates Employed:
Reason for Leaving:
Former Employer #2:
Job Title:
Dates Employed:
Reason for Leaving:
Former Employer #3:
Job Title:
Dates Employed:
Reason for Leaving:
Do you have any previous experience with exchange students?*

YesNo
Please describe your involvement and include the name of the organization that you worked with.*
Why are you interested in the area representative position?*
Please provide a description of your personality:*
Do you have any previous experience working with teenagers?*

YesNo
Please describe:*
Do you speak any foreign languages fluently?*

YesNo
Please elaborate:*
Do you perform any volunteer work in your community?*

YesNo
Please describe:*
What type of personal growth do you anticipate by working for a student exchange program?*
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:*
(Friend, Co-worker, Supervisor, Etc.)
Approximately how long have you known this person?*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Email*
example@example.com

Reference #2:*

First NameLast Name
Relationship to You:*
(Friend, Co-worker, Supervisor, Etc.)
Approximately how long have you known this person?*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Email*
example@example.com

Reference #3:*

First NameLast Name
Relationship to You:*
(Friend, Co-worker, Supervisor, Etc.)
Approximately how long have you known this person?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, 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, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated without prior notice.
Please enter your social security number for IRS income submission.
Date

MonthDayYear
Date
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Area Representative Application

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