STAFF de apoyo - Camp La Llanada Personal Information Question Title * 1. Personal Information First Name Last Name Age Nationality Question Title * 2. Date of birth DOB Date Question Title * 3. Language Native language Second language Second language proficiency (Basic, Intermediate or Advanced) Question Title * 4. Current Occupation Current occupation Ongoing studies (if applicable) Educational Institution Grade or semester Question Title * 5. Do you have a Social Security Number or a Work Permit in the U.S.? Yes No Please explain: Question Title * 6. Do you have any charges pending against you and/or have you ever been convicted of or pleaded “no contest” to a felony or misdemeanor resulting in imprisonment or a fine over $500 during the last ten (10) years? Yes No If yes, please explain: Question Title * 7. Main Contact Info Address City / Town State / Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP / Postal Code Country Email Phone Question Title * 8. How did you find out about us? Social media Internet Others Friend Next
