Circle Ally Application
Name *
Your answer
Address *
Your answer
Phone Number *
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E-Mail *
Your answer
Date of Birth *
Your answer
Spouse Name
Your answer
Spouse Phone Number
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Spouse E-Mail
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Spouse Date of Birth
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Highest Level of Education *
Your answer
Current Employment *
Your answer
How did you hear about Circles? *
Your answer
Why are you interested in being a Circle Ally *
Your answer
Check the boxes below to indicate if you would have a problem working with an individual who is or has: *
Required
If yes to any of the above, please explain:
Your answer
Would you be willing to provide transportation to your Circle Leader if necessary? *
Skills: Please check all that apply *
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If other skills, please list
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Have you ever been convicted of a felony? *
Do you currently have any pending court cases? *
If yes to either of the above, please explain.
Your answer
Please check each box to indicate you understand and agree *
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