Defending Civil Rights Since 1989

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Tester Application

Please complete and submit the following form to be considered for the postion of Civil Rights Tester.

Contact Information

First Name: *

Last Name: *

Email:

Phone: * Ex: 123-456-7890

Address: *

City: *

State: *

Zip Code: * Ex: 12345

Personal Information

Languages Spoken: *

English

Spanish

Other(s) (please specify)

Check all that apply

Other:

Do you own rental property?: *

Rental Property Information:

Please list the amount of rental property you own and location(s)

Have you ever been evicted?: *

Credit History: *

Have you ever been convicted of a felony?: *

Have you ever been convicted of a crime involving fraud or perjury?: *

Primary Source of Income: *

Other:

Employment History

Employer: If applicable

Occupation:

Length of Employment:

Have you ever been dismissed from a job for misconduct involving dishonest, fraud, or theft?: *

Please describe your work history. We use this information to create a tester profile similar to your actual experience: *

Family Information

Maritial Status: *

Spouse/Partner's Name: If applicable

Spouse/Partner's Race:

Other:

Do you have any children: *

Children Information:

Please include how many children you have, their gender, and their ages.

References

Name of Professional Reference: *

Organization: *

Title/Occupation: *

Email:

Phone: * Ex: 123-456-7890

Relationship: *

Please explain how you know this person

Name of Personal Reference: *

Email:

Phone: * Ex: 123-456-7890

Relationship: *

Please explain how you know this person

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Defending Civil Rights Since 1989

Tester Application

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