Local Coordinator Application

Local Coordinator Application

Contact Information
First Name*
Last Name*
City
US State*
Zip Code
E-mail*
Preferred Phone #*
Secondary Phone #
How did you hear about us?*
Basic Information
Gender
Age*
How many years have you lived in your community?
Are you enthusiastic about working with people in your local community?*

YesNo
Do you have experience and or have the ability to work with and oversee teenage youth?*

YesNo
You understand this work is based from home and it is not required to work in an office?*

YesNo
Do you have good communication skills, timely response and follow up?*

YesNo
Have you ever been convicted of a felony?*

YesNo
Are you proficient with completing paperwork, ie: computer skills, scanner?*

YesNo
You understand this work better serves as supplemental income this is not full-time employment?*

YesNo
I certify that I am authorized to work in the United States.*

I Agree
Anything else you would like to add?
Resume (Optional)
Resume (if available)

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