Fair Housing Center Of Washington

Your Name (required)

Alias/ Previous Name (if not applicable, type N/A)

Your Email (required)

Current Address:

Mailing Address:

Complex/Community/HOA Name: (if not applicable, type N/A)

Best Contact Number:

Birthdate:

Sex:

How did you hear about this position?

What is your availability for testing? Our office hours are Monday - Thursday 8:00am - 6:00pm.

Have you been employed in the last 5 years?
---YesNo

have you interned or volunteered with an organization in the last 5 years?
---YesNo

Please submit a statement that explains why you want to be a Tester and what skills or abilities you have that will help you fulfill this role. You may explain in the textbook below (or upload a statement no more than 500 words).

upload statement:

Are you currently looking to rent or purchase housing at the present time?
---yesno]

If yes, please answer the following:
1) Are you looking to purchase or rent?
---purchaserent
2) What type of housing are you looking for (apt/house/etc…)

3) What city/county(s) are you looking in?

4) What will you use this housing for?

Do you derive or have you ever derived any income from the housing industry (lending, sales, rentals, homeowners' or renters' insurance, etc.)?

Have you ever been a Tester?
---YesNo

Are you prevented from lawfully becoming employed in this country because of Visa or immigration status?
---YesNo

Do you have a history of, or any pending, criminal convictions?

WASHINGTON STATE: If we request an investigative consumer report, you have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from us a complete and accurate disclosure of the nature and scope of the investigation we requested. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

Do you agree to a law enforcement criminal background check (investigative consumer report)?
---YesNo

Do you have a valid driver's license?
---YesNo

Do you own, or have regular access to, a car that you can use for testing?
---YesNo

Do you have current auto insurance?
---YesNo

Applicant Declaration of Interest
I am interested in participating as a Tester in the Fair Housing Center of Washington’s testing program. I understand that the information I have provided on this application will be used by FHCW to determine if there are other applicants with similar personal and home-seeking characteristics who could be matched to me on tests.
---YesNo

I understand that if I am selected to participate in the FHCW’s testing program, a representative of FHCW will notify me.
---YesNo

Also, I understand that if I am selected and agree to participate in the FHCW’s testing program, I will be required to attend a 3 hour unpaid Tester training session (unless otherwise stated).
---YesNo

I understand the confidential nature of the testing program that is planned by the FHCW and I agree to cooperate by maintaining this confidentiality, including the application process.
---YesNo

By submitting this form I understand and agree to all of the above provisions under penalty of perjury. Enter full name below.