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Dayton, Ohio 45405

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937-223-6035

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info@mvfairhousing.com

INCLUSIVE COMMUNITY FUND

Application for Tester Position

You may submit your application by completing the online form below. Otherwise, the application is available for downloading in Adobe Acrobat PDF format. After downloading it, print it, complete it and return it to us as indicated on the form.
Tester application form

Name:

First: Middle:

Last: Maiden:

E-mail address:

Social security number:

Present address:

Street:

City: State: ZIP:

How long at address:

Telephone:

Are you 18 years of age or older?Yes No

Are you prevented from lawfully working in the United States because of visa or immigration status?Yes No

Have you ever been convicted of a felony?Yes No (not a disqualification) If yes, please explain:

Employers: List last three employers, starting with last one first.

1) Company:

Street:

City: State: ZIP:

Start date: End date:

Salary: Position:

Reason for leaving:

2) Company:

Street:

City: State: ZIP:

Start date: End date:

Salary: Position:

Reason for leaving:

3) Company:

Street:

City: State: ZIP:

Start date: End date:

Salary: Position:

Reason for leaving:

Do you or your significant other currently hold a real estate license and/or work in the real estate profession, or have you or your significant other held a real estate license or worked in the real estate profession?

Yes No If yes, please explain:

References: Give the names of three persons not related to you, whom you have known at least one year.

1) Name:First: Last:

Street:

City: State: ZIP:

Phone: Relationship: Years acquainted:

2) Name:First: Last:

Street:

City: State: ZIP:

Phone: Relationship: Years acquainted:

3) Name:First: Last:

Street:

City: State: ZIP:

Phone: Relationship: Years acquainted:

Please explain why you are interested in being part of the housing discrimination testing program and what skills you have that make you a good candidate:

Please describe a time when you had to pay close attention to detail:

Please describe your experience in writing narratives and/or reports:

Please rank yourself on the following skills:

Would you have any personal/moral objections if you are provided with a fictional biography that you are to use as background information and/or identification (ex. employment, reason for moving, etc.) when presenting yourself as a home-seeker or apartment seeker?

Yes No

In case of emergency, notify:

First: Last:

Street:

City: State: ZIP:

Phone:

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am hired as an independent contractor (tester), my position may be terminated at any time.

In consideration of my being hired as an independent contractor (tester), I agree to conform to the company’s rules and regulations, and I agree that my position and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company’s option. I also understand and agree that the terms and conditions of my position may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for my being hired as an independent contractor (tester), for any specific period of time, or to make any agreement contrary to the foregoing."

Please indicate your assent to this statement by typing "I AGREE":