Name
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First Name
Last Name
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)
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List all that you are interested in. If you are interested in any position, write "any"
How did you hear about Arizona Serve?
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Have you spoken with an Arizona Serve staff member about the AmeriCorps program? If so, who?
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AmeriCorps Eligibility Requirements
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To serve in AmeriCorps, candidates must meet these three requirements. If you meet the requirements, please check the boxes above.
Freedom Service Leaders Requirements
Note: We have five slots available for this program on an annual basis. It is open to undocumented individuals
Date of Birth
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MM
DD
YYYY
Have you previously served in AmeriCorps?
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Yes
No
Do you have a Level 1 "Identity Verified Print" (IVP) Card?
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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?
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Yes
No
Are you currently facing a charge?
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Yes
No
Are you on probation or parole?
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Yes
No
By writing your name, you certify that the above information is accurate
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Name of last school attended
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Type of degree, certificate, or diploma
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Date received or expected
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MM
DD
YYYY
Do you know or have you studied Spanish?
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Yes
No
Level of fluency
Basic
Intermediate
Excellent
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
Motivational Statement: We want to know what motivates you to apply to AmeriCorps.
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Community Service: Describe how you have reached out to help others and/or how you have been involved in your own community.
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Please share the most challenging project you have worked on. What was your role and why was the project difficult?
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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?
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What do you see as your three greatest strengths you would bring to this (these) position(s)?
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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.
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Date / Time
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