Full Name:
Address:
Street:
City:
State:
Zip code:
Do you rent or own?
How long at this address?
years month(s)
Home Phone #:
Work Phone #:
Birthdate:
Marital Satus:
Education (list all the educational institutions attended/graduated):
Name of institution:
Dates attended/graduated:
Name of institution:
Dates attended/graduated:
Current Employer (if less than 6 months, please include previous employer)
Name:
Address:
Name:
Address:
Have you ever been arrested or convicted on an alchohol or illegal substance charge?
if yes, please explain:
What experience have you had working with teenagers:
What experience have you had working with schools:
Have you had experience with people from other cultures (do you speak another language, have you travelled to other countries, have you interacted with a foreign visitor)?
Please list two references BEE can contact:
Name:
Address:
Phone:
Name:
Address:
Phone:
 
I certify that the information above is truthful and complete to the best of my knowledge.
Please type your name:
Date:

We also need a letter from your references covering this questions

1. How long have you known the above person?________ In what capacity?
2. In your poinion is the person avle to supervise teenagers? Why or why not?
3. Has this person ever to your knowledge abused drugs or alcohol?
4. Is this person reliable and honest?
5. Would you recommend this person for this position?
6. Comments.

Your references need to sign/date a letter and send it us.