Part Time Staff Interest Form By completing the form below, I certify that: I am 16 years of age or older. I am eligible to work in the United States. I have never been convicted of a criminal offense other than a minor traffic violation. My name does not appear on any Sex Offender database. Question Title * 1. Your Name: Question Title * 2. E-mail Address: Question Title * 3. Phone Number: Question Title * 4. Please list 3 dates and times (30 minute time slots) that you are available for an interview at the NWSRA Office, 3000 W Central Road, Rolling Meadows. We will do our best to schedule within these times Date / Time Date Time AM/PM - AM PM Date / Time Date Time AM/PM - AM PM Date / Time Date Time AM/PM - AM PM Upon receipt of the responses to these questions, Erica Stanko, Recruitment Coordinator, will e-mail you to schedule an interview. If you have questions, please contact Erica directly at 847-392-2848, ext. 248 or e-mail ericas@nwsra.org Done