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The Fair Housing Project Tester Application

NOTE TO APPLICANT: The purpose of this form is to determined if you meet criteria necessary for investigation of housing discrimination complaints.

Contact Information
Personal Information
Birthdate
Gender Identity
Marital Status:
Ethinicity
Race (Select one of more)
Do you have a disability?
If Yes, please explain
If you utilize any of the following, please select all that apply
Education (*Required)
Are you a current law student or alum?
Work History
Are You Presently Employed?
Will you be able to conduct a test during your working hours?
In what area(s) will you be able to work?
Do you have access to a car?
What is the make and model of your car?
Have you ever been convicted of a felony?
Have you been or are you currently a Real Estate Agent, landlord, mortgage lender or Insurance Agent?
Do you have a family member who has been or is currently a Real Estate Agent, landlord, mortgage lender or Insurance Agent?
Do you hold any views about the housing industry that would prevent you from being objective, fair, accurate, and unbiased in completing a test?
Have you ever been trained as a "Tester" for a housing discrimination project or study previously:
Have you ever conducted housing discrimination "tests" previously:
Have you ever been an actor or actress before:
How often have you engaged in public speaking:
Testing requires acting an assigned role and assuming some characteristics which are not your own. Are you comfortable with assuming a persona that does not match your own if required by the investigation?
Have you had any experience with providing sworn testimony in a deposition, hearing, or trial?
Are you comfortable with testifying at trial regarding your testing experience if asked?
Are you a government official?
Are you currently looking for housing?
If Yes, what kind?
Do you plan to purchase a home in the near future?
Do you own or rent your home?
Please specify the hours when you are most available for work (*Required)
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Applicant's Statement:

The information provided on this form is, to the best of my knowledge, accurate and complete. I would like to be considered for the position of "Tester." I understand that this application is not for a full or part-time position, and because of the nature of discrimination testing, participation in tests cannot be guaranteed.

I understand that the nature of the relationship between me and the Legal Aid of Arkansas shall remain that of independent contractor and nothing in this document shall be construed as creating the relationship of employer and employee. I understand that I will not be eligible to participate in any employee benefit programs of the Legal Aid of Arkansas or receive any other benefit or compensation benefits. I also understand that the Legal Aid of Arkansas will not pay or withhold any monies for taxes or insurance of any kind, including but not limited to FICA, state and federal income taxes, unemployment compensation and workers' compensation coverage. The payment of any and all taxes shall be my sole responsibility. I also understand that I do not have the authority to enter into any contract of agreement on behalf of the Legal Aid of Arkansas or otherwise bind the Legal Aid Of Arkansas and that I shall not Represent to anyone that I have such authority.

Testers will be paid a stipend after completion of each test. I understand that I am expected to participate fully in training sessions and perform tests in accordance with the training I receive, the Housing Discrimination Testing Manual and any instructions I receive from the Testing Coordinator. I Understand that I must complete the tests that I accept and that after I complete the debriefing associated with a test I will receive and undisclosed amount decided by the Testing Coordinator. I understand that I will not be paid unless I follow the procedures set forth in the Tester Agreement. 

I understand and acknowledge that as a tester I may undergo a criminal background check. I acknowledge that refusal to consent to a criminal background check may result in my not being trained and utilized as a tester, or may result in termination from the Project.

(Full Name Typed Out)
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