Online Application for AmeriCorps

4-H CAPITAL AmeriCorps Instructor Application

Step 1 of 9

MOTIVATIONAL STATEMENT
Please share with us why you would like to serve with the AmeriCorps program.*

EMPLOYMENT HISTORY
Beginning 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 1
Organization:*
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 2
Organization:
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 3
Organization:
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 4
Organization:
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 Experience
Our 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.

COMMUNITY SERVICE
Please 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 Position 1
Organization:
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 position to add?
- Yes
- No
Community Service Position 2
Organization:
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 position to add?
- Yes
- No
Community Service Position 3
Organization:
City:
State:
Phone Number:
Description of involvement:
Date of involvement to (mm/yyyy):
Date of involvement from (mm/yyyy):
Hours Per Month

Criminal Background Check
Because 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
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 INFORMATION
CNCS 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?*
Have you previously served with an AmeriCorps program?*
If answered yes to previously serving in an AmeriCorps program, please provide the name and location of the program below:

References
Please 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 1
Reference name:*
Relationship to applicant:*
Reference 1 E-mail address*
Enter Email Confirm Email
Phone Number:*
Reference 2
Reference name:
Relationship to applicant:
Reference 2 E-mail address
Enter Email Confirm Email
Phone Number:

Online Application for AmeriCorps

4-H CAPITAL AmeriCorps Instructor Application

Step 1 of 9

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.

Basic Information

MOTIVATIONAL STATEMENT

EMPLOYMENT HISTORY

Position 1

Position 2

Position 3

Position 4

Skills and Experience

EDUCATION

Post-secondary School

Post-secondary School 2

Post-secondary School 3

COMMUNITY SERVICE

Community Service Position 1

Community Service Position 2

Community Service Position 3

Criminal Background Check

DEMOGRAPHIC INFORMATION

References

Reference 1

Reference 2

Thank you for applying with 4-H CAPITAL. Please click Submit to complete your application.