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LEAD Program
LEAD Application
Please don't fill out this input box.
APPLICANT INFORMATION
Last Name:
*
First Name:
Date of Birth:
What is your home address? (Not SAU)
Home Address: City
Home Address: State
Please Select
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Home Address: Zip
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Are you a current Southern student?
What is your Southern email address?
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Major:
Are you a citizen of the United States?
*
Yes
No
If no, are you authorized to work in the U.S.?
*
Yes
No
Do you have any canvassing experience?
*
Yes
No
If so, where and when?
Have you ever been convicted of a felony?
*
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No
If yes, explain
REFERENCE
Reference: Full Name
Reference: Relationship
Reference: Company
Reference: Phone
Job Title:
Have you had any other door-to-door experience?
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No
If so, please describe.
Do you have any other jobs (on or off campus)?
*
No, none.
Yes, one.
Yes, two.
Yes, more than two.
Select Shifts You Are Interested In
*
Sunday 2pm-6pm
Monday 3:30pm-7:30pm
Tuesday 3:30pm-7:30pm
Wednesday 3:30pm-7:30pm
Thursday 3:30pm-7:30pm
Thanksgiving Break
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DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature:
*
Date:
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