Become a Fair Housing Tester – Housing Discrimination Tester Application

Contact Information

Name

Address

City

State

Zip Code

Phone (Cell or Home)

Email Address

Date of Birth (Required)

Education

High School

Address

Did you graduate from high school?

Yes

No

Did you attend a college or university?

Yes

No

Employment

Are you currently employed?

Yes

No

Prior Employment

(What other types of work have you performed in the last 5 years? Provide name and address of employer, length of employment, and position.)

Background Information

Do you have access to a vehicle? (required)

Yes

No

In what area(s) will you be available to work? Please check all counties.

Have you ever been convicted of a felony? (required)

Yes

No

(Testers in testing activities funded with FHIP funds must not have prior felony convictions or convictions of crimes involving fraud or perjury, and they must receive training or be experienced in testing procedures and techniques.)

Have you been or are you currently a Real Estate Agent, Landlord, Mortgage Lender or Insurance Agent? (required)

Yes

No

Do you have a family member who has been or is currently a Real Estate Agent, Landlord, Mortgage Lender or Insurance Agent? (required)

Yes

No

Availability

Please specify the hours when you are most available for work.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Why do you want to be a Fair Housing tester?

Signature

Date