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UC Berkeley Residential Life Safety Program
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Registration: UC Berkeley Residential Life Safety Program
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APPLICANT INFORMATION
*
First Name
*
Last Name
*
Email
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Zip/Postal Code
Primary/Home Phone
Mobile Phone
Address
City
State/Province
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
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Maryland
Massachusetts
Michigan
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New York
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Northern Mariana Islands
Ohio
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Rhode Island
South Carolina
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Tennessee
Texas
U.S. Minor Outlying Islands
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Virginia
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Country
United States
United Kingdom
Canada
Germany
Japan
France
Australia
Italy
Austria
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Spain
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Belgium
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Sweden
Norway
Brazil
Portugal
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Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
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Aruba
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia and Herzegovina
Botswana
Bouvet Island
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
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Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic
Cook Islands
Costa Rica
Cote dIvoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
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Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Jamaica
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
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Lao Peoples Democratic Republic
Latvia
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Lesotho
Liberia
Libya
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Lithuania
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Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
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Martinique
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Mauritius
Mayotte
Mexico
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Mongolia
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Montserrat
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Myanmar
Namibia
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Nicaragua
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Nigeria
Niue
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Northern Mariana Islands
Oman
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Palestinian Territory
Panama
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Paraguay
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Philippines
Pitcairn
Poland
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French Part)
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch Part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and The South Sandwich Islands
South Korea
South Sudan
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
ADDITIONAL INFORMATION
Please list/explain any experience you have applicable to this position.
Why do you want to join our team?
How did you hear about us?
CPR Expiration Date
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
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31
Year
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
First Aid Expiration Date
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
*
Uniform Size
Please Select
XS
S
M
L
XL
XXL
XXL
*
Emergency Contact Name
*
Emergency Contact Phone
*
Emergency Contact Relationship
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