Model Staff Application Form (DIV1.DEP1.RECRUT)

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HUBBARD COMMUNICATIONS OFFICE Saint Hill Manor, East Grinstead, Sussex HCO POLICY LETTER OF 1 MARCH 1970	HUBBARD COMMUNICATIONS OFFICE Saint Hill Manor, East Grinstead, Sussex HCO POLICY LETTER OF 1 MARCH 1970
Remimeo	Remimeo
HCO ES Hat	HCO ES Hat
HCO Area Sec Hat	HCO Area Sec Hat
Dept 1 Hat	Dept 1 Hat
MODEL STAFF APPLICATION FORM	MODEL STAFF APPLICATION FORM
Date _________________	Date _________________
I _____________________ (Block capitals) of _______________________ (Permanent Address) _______________________ (City) ___________________ (State) do hereby apply for a post in the ___________________________________ Organization.	I _____________________ (Block capitals) of _______________________ (Permanent Address) _______________________ (City) ___________________ (State) do hereby apply for a post in the ___________________________________ Organization.
I understand that my signing a contract for 2 1/2 years beginning with the date of going on staff, any and all training and processing I will subsequently receive while on contract will be given without charge.	I understand that my signing a contract for 2 1/2 years beginning with the date of going on staff, any and all training and processing I will subsequently receive while on contract will be given without charge.
Mark One.	Mark One.
(a) I wish to go on staff now and sign the contract and a note now and do any further training part time.	(a) I wish to go on staff now and sign the contract and a note now and do any further training part time.
(b) I wish to take my HDC Course first and will sign the staff contract and a note before enrollment understanding that if I break the contract the full fee becomes due and payable and I will be refused further training or processing in any org.	(b) I wish to take my HDC Course first and will sign the staff contract and a note before enrollment understanding that if I break the contract the full fee becomes due and payable and I will be refused further training or processing in any org.
AS A CONTRACTED STAFF MEMBER I REALIZE I WILL RECEIVE MY POWER PROCESSING IN THIS ORG WHEN MY CASE IS FULLY PREPARED FOR IT.	AS A CONTRACTED STAFF MEMBER I REALIZE I WILL RECEIVE MY POWER PROCESSING IN THIS ORG WHEN MY CASE IS FULLY PREPARED FOR IT.
I am male ___ female ___ ___________ years old, born in _____________(Date) in __________________(Town, Country).	I am male ___ female ___ ___________ years old, born in _____________(Date) in __________________(Town, Country).
(If a minor, I will present written consent of parents or Guardian to work in the org with this application.)	(If a minor, I will present written consent of parents or Guardian to work in the org with this application.)
I (have had) (have not had) (mark one out) psychiatric treatment. If so, give details __________	I (have had) (have not had) (mark one out) psychiatric treatment. If so, give details __________
____________________________________________________________________________	____________________________________________________________________________
____________________________________________________________________________	____________________________________________________________________________
____________________________________________________________________________	____________________________________________________________________________
I (take) (have taken) (have not been on) drugs. (Mark out 2.)	I (take) (have taken) (have not been on) drugs. (Mark out 2.)
I am (married) (unmarried). (Mark out one.)	I am (married) (unmarried). (Mark out one.)
My (husband) (wife) (has) (does not have) any objection to my working in the org.	My (husband) (wife) (has) (does not have) any objection to my working in the org.
My parents (have) (do not have) any objections to my working in the org.	My parents (have) (do not have) any objections to my working in the org.
I (am) (am not) connected to persons hostile to Scientology. If so, give details	I (am) (am not) connected to persons hostile to Scientology. If so, give details
___________________________________________________________________________	___________________________________________________________________________
___________________________________________________________________________	___________________________________________________________________________
___________________________________________________________________________	___________________________________________________________________________
My education consists of (give details) ___________________________________________	My education consists of (give details) ___________________________________________
___________________________________________________________________________	___________________________________________________________________________
___________________________________________________________________________	___________________________________________________________________________
I am particularly competent at (give special skills) __________________________________	I am particularly competent at (give special skills) __________________________________
___________________________________________________________________________	___________________________________________________________________________
___________________________________________________________________________	___________________________________________________________________________
If employed, I agree to receive pay proportionate to org income from week to week.	If employed, I agree to receive pay proportionate to org income from week to week.
If employed, I agree to the usual rules and regulations that govern staff members.	If employed, I agree to the usual rules and regulations that govern staff members.
___________________________________________________________________	___________________________________________________________________
Witness Signed	Witness Signed
____________________________________	____________________________________
Witness	Witness
COMPLETE THIS FORM AND GIVE IT TO RECEPTION TO PLACE IN THE BASKET OF HCO DEPT 1.	COMPLETE THIS FORM AND GIVE IT TO RECEPTION TO PLACE IN THE BASKET OF HCO DEPT 1.
CS-1 for L. RON HUBBARD Founder	CS-1 for L. RON HUBBARD Founder
LRH:jz.ei.rd	LRH:jz.ei.rd

MODELSTAFF APPLICATION FORM

MODELSTAFF APPLICATION FORM

MODEL
STAFF APPLICATION FORM

MODEL
STAFF APPLICATION FORM