ࡱ> Y[XM bjbj== sWWl  8  l ~p 888$ 6!8@88j d8jjj8: 8 j8jZj%^JM !Tb  r:=MN0~EDDMj   An Equal Opportunity Employer EEO Information Not for Interview Purposes In accordance with Equal Employment laws, we are required to maintain statistical data on all applicants. We ask for your cooperation in completing and returning the following information. This form will be separated from your application and not used in the screening or interviewing processes. NameDate of BirthAddressTelephone NumberDrivers License NumberState Where IssuedSex:Female MaleRace/Ethnic Group:American Indian Asian / Pacific Islander HispanicBlack White Other (specify) ______________Position Applied For: I hereby authorize any city, county, state or federal agency, department or bureau to release any information in their files under the above name. I understand and realize that the information so released may prove unfavorable to me. 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If you wish to be identified, sign here: Check the box that describes your status: ( Disabled Veteran ( Vietnam Veteran ( Disabled Individual Please Do Not Write Below This Line Background Check Results: Warrant:( No Warrant Found( Active Warrant Indicated________________________________________________________________________________Local Record:( No Record Found( Prior Record (Please Attach)________________________________________________________________________________DL#:( Status Clear( Status Suspended________________________________________________________________________________Signature of Person Conducting Check:   Florida Ave. CampusGrades 9-12 Mass. Ave. CampusGrades 6-12 1346 Florida Ave., NW 2nd Flr. 3855 Massachusetts Ave., NW Washington, DC 20009 Washington, DC 20016 phone (202) 387-6980 % fax (202) 387-7808 phone (202) 244-6177 % fax (202) 244-6170  Developing Young people who will make the country a better place by influencing the public policies that affect their communities JK[~ > E p q   * +   𶨶{(jCJOJQJU^JaJmHnHuCJH*OJQJ^JaJ5CJOJQJ^JaJ5CJOJQJ\^JaJCJOJQJ^JaJjCJUaJmHnHu 6CJaJCJaJ jqCJaJCJaJ56CJaJCJaJ >*CJaJCJaJ0JK[~hm$$Ifl40*j  04 la$If$a$  $Ifm$$Ifl40*j  04 la'7PY_ezppzpppppp & F$If$If~$$IflFpx*0    4 la Z\T$If$$Iflr@ *Jbp  04 layz  F $If$Pa$$a$Z$$Ifl4 **04 la ( ) * + | gL_<$If$$Ifl\V *    04 la$If| } $Ifm$$Ifl40V * F 04 la  mLg_<$If$If$$Ifl\V f!*  N 6 04 la   * > ? $Ifm$$Ifl40V * F 04 la? @ A mLg_($If$If$$Ifl\V *    04 la $Ifm$$Ifl40V * F 04 la  A l ommcc\MF k 8@@  }@p^p` :  p^p`$$Ifl\*  04 lal m >$  $@@^a$ $ N^a$ p^p` k L@@ k @vx6CJOJQJX]^JaJ:CJOJQJaJ6CJOJQJX]^JaJCJaJCJOJQJ^JaJ * 0 0&P1h/ =!"#$%n?'Dg'QhiIDATx^흉v䬮rMU%9yc+1 )m)>BI{FHBx0h p?h_dx!<^&0:E£ Nh_dx!<^&0:E£ Nh_dx!<^&0:]>F3L 6}}~~i{7~/k{c1>f?x} 5v[Iݱd7/K[ ۄHkDH\;Ǐ֎[e!V=«{>Du|N{P7L9[S94/%X7^x?IʮGM)a=R2{kwڃ<ﯷЗ>߱7$ _F>{NOo?:,/n'pϼ>tK.9aa2Ydn|Îrٝߐ{$俋)ՋQ18v%ao-9 0s_Gx?q0@_2^Θcsl4KY&KU@-⿌)Ď-.Fz^P"|z0Jx[ "R*“۲r̹flW،2=k ?{ل|/gjdW^afGSJ_DY+x2}',5S;į[$wr}V"B>>B0N+K@U?[nM6[݋sN _,em?4s+!EwοlJxV[̥Iԇ==~Co E fo<]`WMv FupG+c+zy|[)QůN<ٕ{)swmpƏ;X|=GnE}d 9u%>E{/wuڀO N&!'fGA0=SfA{͵g}i{%z{$ |{cPmٸRe‰6vrR #ut5"zf,,G>0fd?}n{2utAFVPO.fzaBMFF~F ø tgwZS6E`>sU>3$YI+0O5%Np([n P_pb S3L5T .oF5vS%Zr㞩t df]>2!T9[Eo 'e7>L5یlkB>R(-6{kR1$vVB%3XE7]ͫҪgw}}_LE!4wDX*t 2d :E!h6bO-; Y; Dq #wR~lF_̒}Eߴ%h(yw f`CVt& 2q0>UF;!,xbt'pغ/mVn>{׻ѝh~HcIfҼ>|Jr㝖||[ 9ԘP$*g_fn4%g,ߨ{{(D,9 ZUn 'W͍&DGY/n5%R̇|D>Y/}o#bW4HqμcGι E<,o׸PęL i!gs_Ix̞~pw[noOԆI [Cdd^݈ %4B{qF k|M qj{JwA-sw`~ÝSv!Y]qFIG7b65 `J^2 p íKU軇L[(>:Օ(}9;#qa#ҴMQŊV@7_OXww-|Ʃコk.9Ҍ;4t1/X]$5%Epû?ᖉhj f}Gؙ8 G6ǜz8>:dALv ijj^3(]1{w-J”z]Y8Oq*P>ẙ(s-JBpzlqu%r>5 Wl}@ ҁ)t>'\s*ϹIBaV'^>UMÍl>ZekŃxcƤ0Bq˗5).N+8򽅬|aC}J­BϝM`d(=`CMGt]P%Qr]>)s4CRMĘԊ|O &iG!=UU'hl敝Nf *C^R~ױU5#7 "rXjgޣ' PDDk2+H2,m{\)윗٤H_EۆuN"%-~^Fo^2>Ci.""%腇a(lT>]Ϙ\ M܇N~{6aO.ciG\Iޙ03]+ 둭T91v͗0bm%~/^:R¯|L.TnsM%s?bqb;j|R# ߅O0b 6#}`q3Ԇv"^nCnFi~IВ;=+2aJʲo *~TLPwyXL {+n.]X; km"51TĔsU`D'MVaք$)9S ۯ)a7$}b=yVKަ+Ii*]7Q[YG=¡>^["Z42 2;tԉ'"Gf,[ޅD#kgl UP8a|aGz6CUv)ٮ ^ у }]E~>~ox:d#:.c9P60ΝsZhmSPɒzpTdؾh(~1T{gX [@TؘUpUaznVP$ /ɋ O(~x.wl,ư`%'tQaĎ5b,s,WGw)R=8hgZ5!|phTGwjZoKM3e!ɩ;~p&?|M>38vx )!fĠeUΏuDl 7/p=vωMb2NvvOmODy]{"E?t},Gbb )alPo ;l_BkwrIafCk&™^o rbOB`萼K[ ;GTaHI0{Lu: &j3a{:gQ#rב[jPv-њGI a8O!@ g=1 7~::r4mށ0b奮IR)3m㩷W}fcL̲PqỎ # aJ#b຾7qK66{|mNdUEE op=n&փgqREBRdثS.BIj2rwO"*d[f n9gW ( |)KݍCYl؁PW ?` HQXg*#W*_̉M{9˔zsDp&:!lRB=VՁk8P)N86}h ~LwL_A /ߚN8IutnuN]\q5F?yE9*V4O3#kTUW訯Fnׇp\< dRH]giqO+h!8tGf<@ [q ,yS7 mw 7\v{_:^k{]8 Մm+$jp|o .aʒP 0DHij_?Rt &]|7= .$\0Pb'~#$eI M=0O /NOd8 {tḤ~2L$=oҸAAWHydX8SNlhl~S*[6F wJ9$b! 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