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Tobacco Undercover - Screening Application *Massachusetts Residents Only*

All information will be kept private! 

PLEASE NOTE: This program is for Massachusetts residents only.

The following information is required to begin the application process. A FDA Adult Compliance Officer or an associate from the Tobacco Undercover program will be contacting you with the next steps of the application process.
1.First name ONLY*(Required.)
2.Pronouns(Required.)
3.Age - Only youth between ages 16 - 20 are eligible to work for the program (if you will be 16 in 3 months or less, you may be considered). *(Required.)
4.Will you turn 21 in 6 months or less?
5.Do you currently live in or attend school in Massachusetts? (Required.)
6.Please list an email to send the application to: *(Required.)
7.What phone number can we reach you at? *(Required.)
8.What city/town do you live and/or go to school in (MASSACHUSETTS RESIDENTS ONLY)? *(Required.)
9.When are you available to work? Check all that apply.(Required.)
10.Is there anything else you'd like to share about your availability? 
11.How did you hear about this position?(Required.)