AmeriCorps State Application

Name *

First

Middle

Last

Preferred Name, if different then above

Email Address *

Phone *

Current Address *

Address Line 1

City

State

Zip Code

AmeriCorps State position(s) you are applying for: *

List all that you are interested in. If you are interested in any position, write 'any.'

How did you hear about Arizona Serve? *

AmeriCorps Eligibility Requirements *

I am a U.S. Citizen or a 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

To serve in AmeriCorps, candidates must meet the above three requirements. If you meet the requirements, please check the boxes above.

Date of birth *

Have you previously served in AmeriCorps? *

Did you complete your term of service?

Why were you unable to complete your term of service?

Do you have a Level 1 "Identity Verified Print" (IVP) Card? *

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? *

Are you currently facing charges for any offense or on probation or parole? *

By writing your name, you certify that the above information is accurate *

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.

Name of last school attended *

Type of degree, certificate, or diploma *

Date received or expected *

Do you know or have you studied Spanish? *

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.

Click or drag a file to this area to upload.

Organization

Position Title

City, State

Start Date

End Date

Reason for Leaving

Organization

Position Title

City, State

Start Date

End Date

Reason for Leaving

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)? *

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 *