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JAH Provisional Class Application
Thank you for your interest in Junior Auxiliary of Houma! Please fill out the information below and someone will contact you soon. Please note, Provisional Class Training begins every NOVEMBER.
Name *
First Middle Last
Your answer
Preferred Name:
Your answer
Date of Birth: *
Applicants MUST be 21 years of age.
MM
/
DD
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YYYY
Spouses Name:
Your answer
Do you have children?
You are not required to answer this question.
Address: *
Your answer
E-Mail Address *
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Phone number *
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Preferred Method of Contact: *
Occupation/Title:
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Are you a resident of Houma? If yes, how long? *
Your answer
Please tell us why you would like to be a part of Junior Auxiliary of Houma: *
Your answer
Please list any other previous community/volunteer work:
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Is there anything you need to disclose to JAH that could prevent or have an effect on you working with children, in the school system, with law enforcement, or with other community agencies? *
Please answer yes/no - If YES please explain.
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Please list two personal or professional references and their contact information: *
Does not have to be a current JAH member.
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If you know any active, associate, or life member of JAH, please list them below.
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