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Please fill out this application in its entirety. Incomplete applications will not be accepted.
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BASIC INFORMATION
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Your name:
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Email:
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Address:
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City, State,
Zip:
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Cell Phone:
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Home
Phone:
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High School (name and year graduated):
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College (name and current year):
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Is English your first
language?
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Yes
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No
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Are you fluent in another
language?
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Yes
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No
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If yes, please list:
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Have you ever been a part of an
issue or political campaign
before?
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Yes
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No
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If yes, please list activities:
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Yes
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No
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Have you ever been convicted of a misdemeanor or felony crime?
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If yes, please describe. (Note: a prior
conviction is not an automatic bar to the
program. The type of conviction and when it
occured will be evaluated before any
decision is made.)
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Please choose your top three issue area interests (please choose only three):
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Voter education and rights
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Access to and cost of health care and coverage
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Federal and state budget
priorities
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Retirement Security (Social Security and
Medicare)
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Job growth and the economy
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Campaign finance reform (state and national)
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EMPLOYMENT HISTORY
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Please list your past employment, starting with your most recent job first. Please include the
company name, your position, dates employed, and the company phone number.
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Employment #1
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Employment #2
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AVAILABILITY
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Please indicate which days you might be available to work:
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Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
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Additional comments:
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I understand that any untrue, misleading, or omitted information submitted (including any
attached resumes, other written materials, or information provided during interviews) will result in
dismissal, regardless of the time of discovery.
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Name
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Date
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