Xplore Area Coordinator Application
Email address *
First Name *
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Middle Name
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Last Name *
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How many years have you lived in your community?
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Address *
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City *
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State *
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Zip *
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Home Telephone
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Cell Telephone
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Email Address *
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Are you authorized to work in the US? *
Have you previously worked for any international exchange organization?
If yes please give details
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List any local clubs or organizations with which you are a member?
If yes please give details
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What interests you about becoming a coordinator for Xplore USA?
If yes please give details
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Do you have reliable transportation? Please specify:
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Do you have a valid Driver’s License? List State and ID number
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Have you ever been arrested or convicted of a crime? This includes any DUI. If yes, please specify
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