Arizona Serve AmeriCorps Member ApplicationThis service-learning application is for volunteer opportunities in Arizona, specifically our State and National Positions. Name * First Name Last Name Preferred Name If different than above Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country AmeriCorps State position(s) you are applying for: (If you are an internal Public Health Corps Member please write "PHC" + the site) * List all that you are interested in. If you are interested in any position, write "any" How did you hear about Arizona Serve? * Have you spoken with an Arizona Serve staff member about the AmeriCorps program? If so, who? * AmeriCorps Eligibility Requirements * To serve in AmeriCorps, candidates must meet these three requirements. If you meet the requirements, please check the boxes above. I am a US Citizen or lawful permanent resident of the United States I am 17 years old or older I have a high school diploma or a GED or will attain one while in service Freedom Service Leaders Requirements Note: We have five slots available for this program on an annual basis. It is open to undocumented individuals I do not meet the AmeriCorps eligibility requirements, but am interested in other ways to serve. Date of Birth * MM DD YYYY Have you previously served in AmeriCorps? * Yes No Background Check Do you have a Level 1 "Identity Verified Print" (IVP) Card? * Yes No Have you ever been convicted as an adult or adjudicated as a juvenile offender, of any criminal offense by either a civilian or military court other than minor traffic violations? * Yes No Are you currently facing a charge? * Yes No Are you on probation or parole? * Yes No By writing your name, you certify that the above information is accurate * Educational Attainment Education Level * In chronological order below, list schools last attended, location of school, dates of attendance, Major or area of study, degree or certificate attained, and date received or expected. Include trade or technical schools, military training, or employment training programs. Some high school High school diploma or GED Technical school/Apprenticeship Associate's degree Some college Bachelor's degree Graduate degree Other Name of last school attended * Type of degree, certificate, or diploma * Date received or expected * MM DD YYYY Do you know or have you studied Spanish? * Yes No Level of fluency Basic Intermediate Excellent Employment Experience Beginning with your current or most recent position, list and briefly describe the most recent positions that you have held over your last ten years of employment. Include self employment, internships/fellowships, home management, full- or part-time paid or unpaid experience. You may upload a resume in lieu of filling out the below if it address the information below. Organization Position Title City, State Start Date MM DD YYYY End Date MM DD YYYY Reason for Leaving Organization Position Title City, State Start Date MM DD YYYY End Date MM DD YYYY Reason for Leaving Informational Interview Motivational Statement: We want to know what motivates you to apply to AmeriCorps. * Community Service: Describe how you have reached out to help others and/or how you have been involved in your own community. * Please share the most challenging project you have worked on. What was your role and why was the project difficult? * Please share a time you had to do something you had never done before. How did you approach this situation, and what did you learn? * What do you see as your three greatest strengths you would bring to this (these) position(s)? * References Reference 1: Name Reference 1: Occupation Reference 1: Relationship to you Years you have known reference Phone Number for reference (###) ### #### Email address of reference Certification: I understand that before officially being offered an AmeriCorps position, all candidates must submit an application complete with three references. Arizona Serve will explain more about the online application if selected for an interview. By signing this application, I understand and consent to completing all required Corporation for National and Community Service (CNCS) National Service Criminal History Check (NSCHC) background checks and a reference check of any previous AmeriCorps service terms before beginning an offered term of service. Having a criminal history record does not automatically exclude you from National Service. Refusal to participate in the NSCHC process or failure to disclose criminal history information could prevent you from serving in an Arizona Serve AmeriCorps Program. By signing this application, I certify that all of the statements made in this application are true, correct, and complete to the best of my knowledge and are made in good faith. Misinformation or omission of information could result in disqualification or termination as an AmeriCorps member. * Date / Time * Thank you for your application! We will be in contact with you shortly.
