Online Application for AmeriCorps 4-H CAPITAL AmeriCorps Instructor Application Step 1 of 9 11% Welcome to 4-H CAPITAL! Please note that this form will not allow you to save your application before you submit, so plan to complete all pages at one time. Please fill out the form below or contact us at 4-HRecruitment@traviscountytx.gov Basic InformationFirst Name:* Last Name:* Preferred Name: Date of Birth:* Month Day Year E-mail:* Enter Email Confirm Email Phone Number*Current Mailing Address:* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Permanent Mailing Address (if different from current address above): Same as current address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Personal PronounsPlease Select...She/Her/HersHe/Him/HisThey/Them/TheirsPrefer Not to SayLanguages SpokenDo you currently have a valid driver's license, passport, or government-issued photo ID?*Please Select...YesNoAre you a U.S. citizen, national, or legal permanent resident alien of the U.S.?*Please Select...YesNoWhat is your military, veteran, or family member status?*All Honorably Discharged veterans qualify for nomination for the Presidents Volunteer Service Award.Please Select...I am a veteranI am an active duty member of the U.S. Armed ForcesI am a member of the National Guard or Reserve ComponentI am an immediate family member of a veteranI am an immediadte family member of an active duty member of the U.S. Armed ForcesI am not in the military, a veteran, or a family member of someone in the U.S. Armed ForcesCriminal Background CheckBecause this position involves working with vulnerable populations, your eligibility to serve as an AmeriCorps member is contingent upon a multi-part criminal background check (paid for by the program) and includes the following: - Texas state criminal background check - Another states criminal background check (if applicable) -FBI fingerprint check - National Offender Registry Clearance - School district fingerprint check I agree and understand that if I accept a position, 4-H CAPITAL will be require to run the required criminal history checks, and I understand that my eligibility to serve as a Science instructor is contingent upon the results of the checks. I also understand that if I have conviction or if a conviction case is open or pending I may be ineligible to serve.* I have read the above statement and understand its implications. Have you ever been convicted as an adult, or adjudicated as a juvenile offender, of at least one criminal offense by either a civilian or military court?* No Yes If yes, please explain:*Are you currently facing charges for any offense, on probation or parole?* No Yes If yes, please explain:*I understand that making a false statement in connection with the criminal history check, including a false response to the criminal history background question on the AmeriCorps application, makes me ineligible to serve.* No Yes I am applying for*Please Select...a Full-Time AmeriCorps Instructor Position 1700 hrsa Half Time (HT) AmeriCorps Instructor Position 900 hrsPlease answer the following question:*One of the essential functions of this position is to travel to multiple worksites. This may include but is not limited to traveling and transporting materials from our office to school sites or tending to garden beds and live animals on various campuses. 4-H CAPITAL provides materials and equipment for Science Club activities. Mileage is reimbursed for travel from worksite to worksite for those driving personal vehicles. Can you perform this essential function with or without reasonable accommodations? Yes No Feel free to list any questions, comments, or concerns regarding required travel, transporting 4-H Science Club materials, or mileage reimbursement below.Earliest Availability Date (mm/dd/yyyy):*Please provide your earliest date of availability. MOTIVATIONAL STATEMENTPlease share with us why you would like to serve with the AmeriCorps program.* EMPLOYMENT HISTORYBeginning with the most current or most recent position, list and briefly describe up to the last four positions you have held, or your last ten years of employment you have had. Include self-employment, internships/fellowships, home management, and full- or part-time paid or unpaid work experience. I do not have any previous employment experience. Position 1Organization:* City:* State:* Supervisor Name:* Supervisor Phone Number:*Supervisor E-mail:* Enter Email Confirm Email Job Title:* Job Duties:*Reason for Leaving:* From (mm/yyyy):* To (mm/yyyy):* Hours Per Week:*Do you have a second position to add?* Yes No Position 2Organization: City: State: Supervisor Name: Supervisor Phone Number:Supervisor E-mail: Enter Email Confirm Email Job Title: Job Duties:Reason for Leaving: From (mm/yyyy): To (mm/yyyy): Hours Per Week:Do you have a third position to add?* Yes No Position 3Organization: City: State: Supervisor Name: Supervisor Phone Number:Supervisor E-mail: Enter Email Confirm Email Job Title: Job Duties:Reason for Leaving: From (mm/yyyy): To (mm/yyyy): Hours Per Week:Do you have a fourth position to add?* Yes No Position 4Organization: City: State: Supervisor Name: Supervisor Phone Number:Supervisor E-mail: Enter Email Confirm Email Job Title: Job Duties:Reason for Leaving: From (mm/yyyy): To (mm/yyyy): Hours Per Week:Skills and ExperienceOur program works with youth in Elementary and Middle-School and provides high quality science expereinces to youth. Please highlight or describe any experience you have in Science and working with youth. EDUCATIONHighest Level of Education*Check the highest level of education that you will have completed by the time you are planning to serve in AmeriCorps. Less than high school High school diploma/GED Technical school/apprenticeship/vocational Some college Associates degree (AA) College graduate Graduate degree (e.g. MA, PhD, MD, JD) Post-secondary SchoolStarting with the most recent, list all schools after high school that you have attended, including trade or technical schools, military training, and employment training programs. Name of school (most recent first): Location of school (City, State): Attended from (mm/yyyy): Attended through (mm/yyyy): Major area of study: Type of degree or certificate: Date received or expected (mm/yyyy): Do you have another school to add? Yes No Post-secondary School 2Name of school: Location of school (City, State): Attended from (mm/yyyy): Attended through (mm/yyyy): Major area of study: Type of degree or certificate: Date received or expected (mm/yyyy): Do you have a third school to add? Yes No Post-secondary School 3Name of school: Location of school (City, State): Attended from (mm/yyyy): Attended through (mm/yyyy): Major area of study: Type of degree or certificate: Date received or expected (mm/yyyy): COMMUNITY SERVICE/VOLUNTEERPlease list the organizations with which you've performed volunteer or community service. List your most recent activity first. Your involvement could include serving in neighborhood, school, religious, social, professional, or other volunteer groups; helping out with community service projects; or participating in less formal activities. I do not have any community service experience. Community Service/Volunteer Position 1Organization: City: State: Phone Number:Description of involvement:Date of involvement from (mm/yyyy): Date of involvement to (mm/yyyy): Hours Per Month:Do you have another community service/Volunteer position to add? Yes No Community Service/Volunteer Position 2Organization: City: State: Phone Number:Description of involvement:Date of involvement from (mm/yyyy): Date of involvement to (mm/yyyy): Hours Per Month:Do you have a third community service/ Volunteer position to add? Yes No Community Service/Volunteer Position 3Organization: City: State: Phone Number:Description of involvement:Date of involvement to (mm/yyyy): Date of involvement from (mm/yyyy): Hours Per Month As an AmeriCorps member you may be eligible for forbearance on your qualified student loans during your term of service. Forbearance is granted by the Financial Institution, not by CNCS, and depends on both the Financial Institution and type of loan that you have. If you plan to place your student loans on forbearance, it is important to check with your Financial Institution because some types of loans may not qualify. I understand that I can find more information about loan forbearance on my.americorps.gov, and that links to CNCS sponsored help pages were provided in the Program Description PDF.* I understand that I am responsible for determining if my loans qualify for forebearance Does not apply DEMOGRAPHIC INFORMATIONCNCS gathers information about sex, race, ethnicity, and other demographic information to ensure opportunities are provided to serve for people of all conditions. This information will be held confidentially and will solely be used for data analysis to assist us in ensuring we serve all Americans equally. The information you provide will not be used in any way to determine or affect any federal benefit. Your responses about ethnic or racial origin are voluntary on this application but will be required to be enrolled as an AmeriCorps member. This information will be kept confidential.Which of the following categories best describes your racial origin? Check all that apply. American Indian or Alaska Native Asian or Asian American Black or African American Latina/o/x OR Hispanic Native Hawaiian or other Pacific Islander White Other How did you hear about this program?*Please Select...4-H CAPITAL WebsiteAmeriCorps online recruitment systemCurrent or Former AmeriCorps MemberCollege resource fairRecruitment BrochureCraigslist, Indeed, or other job search web pageSocial Media (Facebook, Twitter, Instagram, etc.)Dana Haddad - ServeAustin RecruiterOtherHave you previously served with an AmeriCorps program?*Please Select...YesNoIf answered yes to previously serving in an AmeriCorps program, please provide the name and location of the program below: ReferencesPlease provide us with 1-2 professional references. Acceptable references may include the following: job supervisor, intern supervisor, volunteer supervisor, work colleague, college instructor, etc. (Note: Family members and friends are not considered professional references.) Reference 1Reference name:* Relationship to applicant:* Reference 1 E-mail address* Enter Email Confirm Email Phone Number:*Reference 2Reference name: Relationship to applicant: Reference 2 E-mail address Enter Email Confirm Email Phone Number: If you are chosen for an interview, please let us know the best time to schedule your interview. These can be in-person (if residing in Austin) and on Zoom (a link will be sent prior). Interviews typically last less than an hour -- the time ranges below are simply to learn your best availability* Select All Monday, 9:00-12:00pm, Central Time Monday, 1:00-6:00pm, Central Time Tuesday, 9:00-12:00pm, Central Time Tuesday, 1:00-6:00pm, Central Time Wednesday, 9:00-12:00pm, Central Time Wednesday, 1:00-6:00pm, Central Time Thursday, 9:00-12:00pm, Central Time Thursday, 1:00-6:00pm, Central Time Friday, 9:00-12:00pm, Central Time If unavailable, what other days (M-F) and times (9am-6pm, Central Time) would be better for you?*Thank you for applying with 4-H CAPITAL. Please click Submit to complete your application. Δ