Name

First Name

Last Name

Phone

(###)

###

####

Gender

Male

Female

Birthday

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you a citizen of the United States?

Yes

No

Have you ever worked for Anothen Preschool Academy or Camp Anothen?

Yes

No

Have you been convicted of a crime?

Yes

No

Have you ever been convicted of crimes of a sexual nature?

Yes

No

Have you ever been convicted of child abuse or neglect?

Yes

No

Did you graduate high school?

Yes

No

Did you attend college?

Yes

No

Have you ever worked with children?

Yes

No

Character References *

Please list 3 people that Anothen Outdoor Academy can reach out to as a character reference. You must list 1 PROFESSIONAL REFERENCE and 2 PERSONAL REFERENCES (this must be someone over the age of 18, not related to you, but knows you personally.)

First Name

Last Name

Reference Phone Number

(###)

###

####

Character References *

Please list 3 people that Anothen Outdoor Academy can reach out to as a character reference. You must list 1 PROFESSIONAL REFERENCE and 2 PERSONAL REFERENCES (this must be someone over the age of 18, not related to you, but knows you personally.)

First Name

Last Name

Reference Phone Number

(###)

###

####

Character References *

Please list 3 people that Anothen Outdoor Academy can reach out to as a character reference. You must list 1 PROFESSIONAL REFERENCE and 2 PERSONAL REFERENCES (this must be someone over the age of 18, not related to you, but knows you personally.)

First Name

Last Name

Reference Phone Number

(###)

###

####