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Chat X Planet Moderator / Staff Application

Please fill out this application if you wish to be considered for a Mod position with ChatXPlanet.

All information asked for on this application is required and will remain strictly confidential.

Chat Nickname:
First Name:
Last Name:
Valid Email Adress:
Re-Type Email Adress:
Date Of Birth:
Address:
City:
State:
Zip / Postal Code
Country:
Telephone Number:
For emergencies only!
Room You Would Like To Mod:
Days Of The Week You Can Mod: - Monday - Tuesday - Wednesday
check all that apply - Thursday - Friday Saturday - Sunday

Times You Would Be Available:
enter starting and ending time increments  
Do You Have Past Mod Experience?
If "Yes", At What Chat Site?
If "Yes", Are You Still An Active Mod?
Are You Experienced With Chat Commands?
What Platform Will You Be Using?
If Selected, Will You Follow The Guidelines?

Please Tell Us Why We Should Choose You To Be A Mod For ChatXPlanet.Com
(Maximum characters: 200)
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Do you agree to follow the rules and enforce them?  
- Will Clear ALL Fields!
Submitting does not guarantee acceptance!  
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