STS Foundation - Call Us Today 1-800-522-4678

Area Representative Application Form

Name
SSN
Home Address
City
State
ZIP
E-Mail
Years at address
Rent or Own	Rent Own
Phone(day)	format:xxx-xxx-xxxx
Phone(evening)
Briefly describe why you would like to be an area representative with STS Foundation:
Describe your experience with teenagers:
Have you had any training and/or experience in counseling? If so please describe:	Yes No
Describe any experience(s) you have had with international/intercultural exchange:
Are you currently employed?	Yes No

Please name your place of employment including address:
What is the name of your local High School?
Please give your supervisor's name and phone number:	Name: Number:
If you have worked for your present employer for 3 years or less, please name your previous employer:
Do you have a criminal record?	Yes No
Has your driver's license been revoked or suspended?	Yes No
Please list the name, address, and phone number of three references(non-relatives)
You may click the print button now to keep a copy of the application for your records before hitting submit
Department of State regulations require that all employees complete a criminal backgrpound check. Please complete the background check here.