Area Representative Application

Do you have any previous experience with exchange students? *

Yes No
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? *

Yes No
Please describe: *
Do you speak any foreign languages fluently? *

Yes No
Please elaborate: *
Do you perform any volunteer work in your community? *

Yes No
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 Name Last Name
Relationship to You: *
(Friend, Co-worker, Supervisor, Etc.)
Approximately how long have you known this person? *
Address *

Street Address

Street Address Line 2

City State

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.
Date

Month Day Year
Date
Please type your name below as an electronic signature. *

First Name Last Name
Should be Empty: