peace * love * journey * destiny * spirit - "IMAGINE"
REQUESTED OR INVITED SUPPORT STAFF ONLY

PLEASE FILL OUT ALL THAT APPLIES TO YOU AND YOUR POSITION










THIS FORM IS FOR INVITED PERSONNEL, INSTRUCTORS AND/OR GUEST SPEAKERS ONLY (Includes SUSO FY17)
Name:
Professional / Stage Name
Address:
Phone: (including cell number)
Email:
Website: (if applicable)
Nationality:
Gender:
Are You Over The Age of 18 Years Old? Yes or No
Over The Age of 18 Years Old?
Over The Age of 25 Years Old?
Between the ages of 30 and 40 years old?
Between the ages of 40 and 50 years old?
Between the ages of 50 and 60 years old?
Over the age of 60 years old?
Do You Speak Any Languages Other Than English? (if yes what are they)
What is Your Job Position, Class Topic, Training or Concept you are applying for or plan to offer? If you have more than one please list each one for consideration.
If you are going to work, speak or give a lecture please give a brief description of the job position or topic.
Which Class Age Group Would Benefit from your Class or Speech? (Please Select all that Apply)
Peace Group (5-7)
Love Group (8-12)
Journey Group (13-17)
Destiny Group (18-up)
Spirit Group (adult)
Are there specific materials needed to facilitate your job position or workshop? If so, please list them.
Let us know if there are any conflicts with the times or locations?
Check Categories of Job Position, Topics, Talents or Experiences (Please Select all that Apply)
Yoga
Dance
Acting
Writing
Speaker
Modeling
Meditation
Instruments
Arts & Crafts
Photography
Sound Engineer
Video Production
Charm & Etiquette
Fitness & Nutrition
Lighting Technician
Music (Vocals, Rap, Lyrics, Engineer)
Beauty (Skincare, Makeup & Hair Care)
Timekeeper
Supervisor
Bookeeper
Grant Writer
On-Site Manager
Administrative Assistant
Are you available to work with the program between the following timeframes on MONDAYS? Please check all that apply. (IF APPLICABLE)
MORNING Time 8:00 am - 12:00 pm
FULL DAY Time 8:00 am - 6:00 pm
MIDDAY 11:00 am - 2:30 pm
AFTERNOON Time 2:30 pm - 6:00 pm
Are you available to work with the program between the following timeframes on TUESDAYS? Please check all that apply. (IF APPLICABLE)
MORNING Time 8:00 am - 12:00 pm
FULL DAY Time 8:00 am - 6:00 pm
MIDDAY 11:00 am - 2:30 pm
AFTERNOON Time 2:30 pm - 6:00 pm
Are you available to work with the program between the following timeframes on WEDNESDAYS? Please check all that apply. (IF APPLICABLE)
MORNING Time 8:00 am - 12:00 pm
FULL DAY Time 8:00 am - 6:00 pm
MIDDAY Time 11:00 pm - 2:30 pm
AFTERNOON Time 2:30 pm - 6:00 pm
Are you available to work with the program between the following timeframes on THURSDAYS? Please check all that apply. (IF APPLICABLE)
MORNING Time 8:00 am - 12:00 pm
FULL DAY Time 8:00 am - 6:00 pm
MIDDAY Time 11:00 pm - 2:30 pm
AFTERNOON Time 2:30 pm - 6:00 pm
re you available to work with the program between the following timeframes on FRIDAYS? Please check all that apply. (IF APPLICABLE)
MORNING Time 8:00 am - 12:00 pm
FULL DAY Time 8:00 am - 6:00 pm
MIDDAY Time 11:00 pm - 2:30 pm
AFTERNOON Time 2:30 pm - 6:00 pm
PLEASE SELECT WHETHER YOU'RE AVAILABLE FOR THE FOLLOWING MANDATORY TRAINING DATE & TIME?
Staff Training: 6:00 pm-8:30 pm Tuesday - 11/29/16
Did you complete a TB testing?
Yes
No
Have you completed the required Security Clearances?
Yes
No
Which "Imagine" Representative, Staff Member, Student or Affiliate referred you? Please give us their name, their organization name and/or their staff position.