Online Staff Application

Thu, 07/17/2008 - 20:34 — orion

Please complete this form to apply to staff:
(Fields marked with a green * are MANDATORY)

Staff Dates: *

September 24-26, 2010 – Yucaipa, CA (Southern California)

November 12-14, 2010 – Vernonia, OR (outside of Portland)

First Name: *

Last Name: *

Address: *

City: *

ST: *

ZIP: *

Email: *

Make sure there are no spaces before or after your email address.

Date of Birth: *

Home Phone:

Work Phone:

Occupation:

Health Conditions:

(e.g., pregnant, blood pressure, back problems)

Medications:

Medical Certications:

None

LVN

CPR Certification:

First Aid Certification:

Number of Times Staffed: *

(If more than 5, approximate number is okay)

Where and When Last Staffed:

What Jobs Have You Done:

Completion Dates

(If you don't know the exact "day" simply select "1")

Woman Within Training: *

WEW:

One Day Staff Training:

WW Leadership Training:

E-Circle Training:

I am FAC Level (for women on the WWI Facilitation Track): *

None

Friend or Relative Enrolled:

If you have a friend or relative attending this weekend, indicate her name and relationship to you.

Comments (including job preference):

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