Applicant Information

Last Name

First

M.I.

Date

Street Address

Apartment/Unit #

City

State

ZIP

Phone

E-mail Address

Talent Description:

Social Security No.

Drivers License No.

Have you competed in a pageant before:

                                                                         Where:

Are you a citizen of the United States?

YES 

NO 

Current Age:

Will you submit to a background check?

YES 

NO  

Possible Platform Topic:

Have you ever been convicted of a felony?

YES 

NO 

Can you travel?  

Do you currently have a sponsor for the pageant:

Education

High School

Address

From

To

Did you graduate?

YES 

NO 

Degree

College

Address

From

To

Did you graduate?

YES 

NO 

Degree

Other

Address

From

To

Did you graduate?

YES 

NO 

Degree

References

Please list three references.

Full Name

Relationship

Company

Phone

(           )

Address

Full Name

Relationship

Company

Phone

(           )

Address

Full Name

Relationship

Company

Phone

(           )

Address

Previous Related Experience or Employment:

Company

Phone

(           )

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving

May we contact them for a reference?

YES 

NO 

Company

Phone

(         )

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving

May we contact them for a reference?

YES 

NO 

Company

Phone

(         )

Address

Supervisor

Job Title

Responsibilities

From

To

Reason for Leaving

May we contact them for a reference?

YES 

NO 

Other information you think we should know:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to becoming a contestant with the Brea Scholarship Pageant, I understand that any false or misleading information in my application or interview may result in my release.

Signature

Date