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Personal Information

NAME
ADDRESS
CITY
STATE ZIP
HOME TEL. WORK TEL.
FAX
EMAIL
SS NUMBER

Which program are you applying for: YES FLEX PAX

 

Where did you hear about us?

If Local Newspapers
Please list the local newspaper(s) in which you heard about us

 

Education
Please list name of school(s), years completed and degree awarded.

 

Employment History
Please list employer, position, dates employed and reasons for leaving (please list current or most recent job first).

 

Volunteer or Related Experience
Please list organization, position and dates/length of service.

 

Travel/Languages
Please list any intercultural experience and any foreign languages spoken. Such experience and skills are helpful, but are not requirements of the position.

 

Skills and Experience
Please tell us about any relevant skills and experience. Be sure to detail any volunteer experience, and to list any experience working with teens or families, counseling or sales experience, professional associations, community activities or religious activities.

 

Why PAX?
Please tell us why you would like to become a PAX Community Coordinator. What do you feel you would like to contribute to the program? What benefits and rewards would you like to receive from your participation?

 

Area High Schools
Please list those high schools in which you'd like to enroll PAX students

 

Local Newspapers
List the name of the paper, the area served, and the frequency of distribution. Please list at least one daily and one weekly paper that serve your community.

References
Please provide four references who are not family members, two personal and two professional.

FIRST REFERENCE
RELATIONSHIP
YEARS KNOWN
TELEPHONE

SECOND REFERENCE
RELATIONSHIP
YEARS KNOWN
TELEPHONE

THREE REFERENCE
RELATIONSHIP
YEARS KNOWN
TELEPHONE

FOUR REFERENCE
RELATIONSHIP
YEARS KNOWN
TELEPHONE



To expedite your inquiry, please call or e-mail PAX to confirm that your application was received.