AmeriCorps State Application

This application is for Arizona Serve State and National Positions. To apply for one of our AmeriCorps VISTA Positions, please follow the link in each position to fill out an application at my.americorps.gov.

- Step 1 of 8

Name *

First

Middle

Last

Preferred Name, if different then above

Email Address *

Phone *

Current Address *

Address Line 1

City

State

Zip Code

Is your permanent address different than above? *

Permanent 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.'

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 *

Veteran/Military/Family Status *

Yes, I and/or a family member is in the military or is a veteran
No, I nor my family members are in the military or are veterans

Have you previously served in AmeriCorps? *

Which AmeriCorps Program did you serve with?

AmeriCorps VISTA
AmeriCorps State and National
AmeriCorps NCCC
I don't know

Start date of service

End date of service

Did you complete your term of service?

Why were you unable to complete your term of service?

Previous Names Used, if any *

The AmeriCorps application process requires a criminal history check to ensure the protection of community members with whom we work, particularly children, individuals with disabilities, and individuals over 60 years old. We are investigating for past sexual offences and violent crimes, or crimes that would have a direct bearing on your service. This background check will entail a search of the National Sex offenders Registry and an FBI criminal history check, which will require you being fingerprinted as part of orientation. You will not be permitted to serve or work with children, individuals with disabilities, or individuals over 60 years old without supervision until the background check is complete and you are cleared. The review process is not lengthy and is normally completed within weeks.

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

IVP Card Number

Original issue date

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? *

Charge

You may send us any additional information or explanation in a separate document and upload it below

Date of Charge

City and State of charge

Additional information on charges

If you wish, you may provide us with additional information on your charges. You may upload a Word Document (.doc) or a PDF.

Action Taken

Name of Court, Probation, or Parole Offical

If applicable

Phone number of official

Address of official

Address Line 1

City

State

Zip Code

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

Motivational Statement: we want to know what motivates you to apply to AmeriCorps. Consider the experiences that have made you the person you are today and share with us, in 500 words or less, how one of those experiences sparked your interest in community service. *

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 *

Start Date *

End date or expected end date *

Area of study or major *

Type of degree, certificate, or diploma *

Date received or expected *

Add additional school?

Name of 2nd school attended

Start date

End Date

Area of study or major

Type of degree, certificate, or diploma

Date received

Add another school?

Name of school attended

Area of study or major

Start date (copy)

End Date (copy)

End date

Date received

Do you know or have you studied any language other than English? *

What language?

Level of fluency

Basic
Intermediate
Excellent

Skills and Experience

Listed below are skill areas that some programs find useful and may seek AmeriCorps applicants. Indicate the skill areas in which you have had training or experiences, including volunteer or community service experience, and indicate how you gained those skills. If you have no experience, leave blank.

Architectural Planning

Business/Entrepreneur

Communications

Community Organization/Development

Computers/Technology

Conflict Resolution

Counseling

Education

Fine Arts/Crafts

First Aid

Fundraising/Grant Writing

Law

Leadership

Medicine

Outreach

Public Health

Public Speaking

Recruitment

Teaching/Tutoring

Trade/Construction

Writing/Editing

Youth Development

Other (specify)

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

End Date

Reason for Leaving

Add additional employment experience

Check here to add another employment experience

Organization

Position Title

City, State

Start Date

End Date

Reason for Leaving

Add another employment experience

Check here to add another employment experience

Organization

Position Title

City, State

Start Date

End Date

Reason for Leaving

Add employment experience

Check here to add another employment experience

Organization

Position Title

City, State

Start Date

End Date

Reason for Leaving

Community Service: Describe how you have reached out to help others and/or how you have been involved in your own community. Explain why you decided to serve or get involved and what you learned or how it made you feel. Think in broad terms. Your involvement could inclde serving in neighborhood, social, religious, professional, or other volunteer groups; helping out with community service projects, or less formal activities. Below, list community service or volunteer activities. *

Name of organization where community service was provided

City, State of organization

Phone, email, or website of organization

Start date

End date

Describe your involvment

Add additional experience

Check box to add additional experience

Name of organization where community service was provided

City, State of organization

Phone

Start date

End date

Describe your involvement

Reference 1: Name

Reference 1: Occupation

Reference 1: Relationship to you

Years you have known reference

Phone number for reference

Email address of reference

Second Reference

Check to add additional reference

Reference 2: Name

Reference 2: Occupation

Reference 2: Relationship to you

Years you have known reference

Phone number for reference

Email address of reference

Third Reference *

Check to add third reference

Reference 3: Name

Reference 3: Occupation

Reference 3: 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 *

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