Tester Application – Louisiana Fair Housing Action Center

Name

First Last

Email

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer*

Job Title*

Do you currently/have you ever (please check all that apply):*

Owned or managed rental property?
Worked as a real estate agent?
Worked as an insurance agent?
Worked as a loan officer?
Worked as a loan officer in a home mortgage lending institution?
None of the above

If yes to any of the above, please describe when and where you held these positions.

Do you have family members or close friends who currently (please check all that apply):*

Owned or managed rental property?
Worked as a real estate agent?
Worked as an insurance agent?
Worked as a loan officer?
Worked as a loan officer in a home mortgage lending institution?
None of the above

If yes to any of the above, please describe who held the position, your relationship to that person, when and where they held these positions.

Have you ever been convicted of a felony or crimes of moral turpitude (theft, fraud or perjury)?*

Yes
No

Have you ever been dismissed from a job for misconduct involving dishonesty, fraud, and/or theft?*

Yes
No

If yes to either of above, please explain.

Are you willing to submit to a criminal background check?*

Yes
No

If no, explain.

As a tester, you may be required to testify under oath in a court of law. Is there anything in your past that may affect your credibility as a witness?*

Yes
No

Have you ever experienced discrimination?*

Yes
No

If yes, please explain.

Have you ever filed a complaint of discrimination with a local or federal agency, in state, federal, or county court, or with an employer?*

Yes
No

If yes, please explain.

Are you comfortable working with an organization involved in civil rights law enforcement?*

Yes
No

Have you ever engaged in fair housing testing or auditing?*

Yes
No

If yes, please provide name of agency/organized and dates of employment.

Civil rights testing & investigation involves posing as a particular type of individual during business transaction in order to gather information about the kind of service you receive. Are you comfortable pretending to have certain financial and professional characteristics that are different from your own?*

Yes
No

Physical Appearance

Because this project involves civil rights testing, we have to ask you some questions about your physical appearance in order to match you with other persons applying to work on this project. Please only fill out if you are comfortable providing this information.

Year of Birth*

Please enter a number from 1900 to 2021.

Height*

Weight*

Gender*

Race and Identity*

Do you identify as lesbian, gay, bisexual, transgender, or queer?*

Yes
No

Hair Length/Type*

Please list any visible piercings or tattoos.*

Languages spoken fluently (please list)*

Do you have any children? If yes, please list age(s) and gender(s).*

Do you have regular access to a car that can be used for testing?*

Yes
No

If yes, please provide make and model.

During a normal week, what is your availability for testing?*

How did you hear about LaFHAC testing?*

Please provide the name and telephone numbers of two people who will always know how to contact you.*

Please provide the name and telephone numbers of two people (different from those just listed) who will be able to act as references, that have known you for at least five years, and who are not members of your immediate family.*

Please list all social media you currently use.*

Are you easily identifiable by someone 'googling' you?*

Reporting your experiences is an important part of testing. Please write 3 or 4 sentences about why you want to become a tester.*

By signing (typing your full name) below, you affirm that all of the above is true to the best of your knowledge and recollection.*

Today's Date*