Online Application for AmeriCorps

4-H CAPITAL AmeriCorps Instructor Application

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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
First Name:*
Last Name:*
Preferred Name:
Date of Birth:*
MM
DD
YYYY
E-mail:*
Enter E-mail Confirm E-mail
Are you a U.S. citizen, national, or legal permanent resident alien of the U.S.?*
- Yes
- No
Current Mailing Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Permanent Mailing Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Phone Number:*
Secondary Phone Number:
Preferred Method of Communication:
- E-mail
- Phone call
- Text
- No preference
I am applying for:*
- a Full-time AmeriCorps instructor position
Earliest Availability Date (mm/dd/yyyy):*
Please provide your earliest date of availability.
Latest Availability Date (mm/dd/yyyy):*
Please provide your latest date of availability, or type "available indefinitely."
What is your miliary, veteran, or family member status? Check all that apply.*
All Honorably Discharged veterans qualify for nomination for the Presidents Volunteer Service Award.
- I am a veteran
- I am an active duty member of the U.S. Armed Forces
- I am a member of the National Guard or Reserve Component
- I am an immediate family member of a veteran
- I am an immediate family member of an active duty member of the U.S. Armed Forces
- I am an immediate family member of a National Guard Member or Reservist
- I am not in the military, a veteran, or a family member of someone in the U.S. Armed Forces

MOTIVATIONAL STATEMENT
We would like to understand more about you and your reasons for applying to AmeriCorps. Please share with us why you would like to serve with the AmeriCorps program.*

SKILLS AND EXPERIENCE
SKILLS
Listed below are skill areas that some programs find useful and may seek in AmeriCorps applicants. Indicate the skill areas in which you have had training or experience, including volunteer or community service experience. This is not an exhaustive list of skills. If you have additional skills, please enter the skill in the 'other' field below.*
- Architectural Planning
- Business/Entrepreneur
- Communications
- Community Organization
- Computers/Technology
- Conflict Resolution
- Counseling
- Education
- Fine Arts/Crafts
- First Aid
- Fundraising/Grant Writing
- Law
- Leadership
- Medicine
- Public Health
- Public Speaking
- Recruitment
- Teaching/Tutoring
- Trade/Construction
- Writing/Editing
- Youth Development
- Environment
- Non-profit Management
- Social Services
- Urban Planning
- Disaster Services
- Veterans
- Team Work
- Other
Please specify:
Please elaborate on how you have acquired and applied each of the skills you selected.*
Interests
In the space provided below, please provide any additional interest, skill, experience, or additional information that may be helpful in evaluating your application.
CERTIFICATIONS
List all current certificates along with their expiration dates. Example: EMT -- expires 12/31/2014
Do you have any certificates to add?
- Yes
- No
Certificate:
Expiration Date (mm/dd/yyyy):
Do you have a second certificate to add?
- Yes
- No
Certificate:
Expiration Date (mm/dd/yyyy):
Do you have third certificate to add?
- Yes
- No
Certificate:
Expiration Date (mm/dd/yyyy):
Do you have a valid government-issued driver's license?*
- Yes
- No
LANGUAGES
Is English your primary language?*
- Yes
- No
Do you speak any other languages?*
- Yes
- No
Language:
Fluency:
- Basic
- Good
- Excellent
Add another language?*
- Yes
- No
Language:
Fluency:
- Basic
- Good
- Excellent
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:
Employment Gaps or No History
Please explain any gap in employment greater than six months not accounted for by AmeriCorps, Peace Corps, work, school, or military service. Or, explain why you have no employment history.

EDUCATION
Highest 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 School
Starting 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 2
Name 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 3
Name 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
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.
Why Do I Volunteer?
Describe how you have reached out to help others and/or how you have been involved in your own community. Explain why you serve or get involved, and what you received in return -- that is, what you have learned or how it has made you feel. Think in broad terms.
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 HISTORY QUESTIONNAIRE
The AmeriCorps application process requires a criminal history check to ensure community members with whom we work are protected, particularly children, individuals with disabilities, and individuals over 60 years old. We are investigating for past sexual offenses 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 Public Registry and may include a statewide criminal history repository check and/or a FBI criminal history check, which will require you to submit fingerprints. You will not be permitted to serve or work with children, individuals with disabilities, or individuals over 60 years of age, without supervision, until the history check is complete and you are cleared. The review process is not lengthy and normally is completed within weeks. Answer the following questions fully. Existence of a criminal conviction or juvenile adjudication may or may not, depending on circumstances, disqualify you from consideration. However, any intentional misrepresentation or omission is grounds for disqualification. Answer the following questions and include misdemeanors and any offense that led to pre-trial intervention and/or fines other than speeding or parking tickets.
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:*

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? Check all that apply.*
- 4-H CAPITAL website
- AmeriCorps online recruitment system
- Current or former AmeriCorps member
- College resource fair
- Recruitment brochure
- AmeriCorps recruiter/representative
- Job search web page
- Craigslist
- Austin EcoNetwork
- Social Media (Facebook, Twitter, Instagram, etc.)
- Guidance counselor/teacher
- Parent/relative
- Friend
- Article (online, newspaper, or magazine)
- Advertisement in a newspaper/magazine
- TV commercial
- Radio commercial
- Received information in the mail
- AmeriCorps program poster
- State Service Commission
- Other
Please specify:
Have you previously served with an AmeriCorps program? Check all that apply.*
- State and National
- VISTA
- NCCC
- None

REFERENCES
You must submit two references with this application. You should select people whom you know well and who are familiar with your personal background, education, employment, and/or professional skills. You should NOT ask a family member, peer, classmate, co-worker, or friend to serve as a reference. Consider asking work supervisors, clergy, teachers, counselors, coaches, or someone else familiar with your motivation and community involvement. In order to complete a reference request, you will need the reference's name, e-mail, and phone number. Further, all reference requests will be submitted via e-mail, so please check that the e-mail you provide is valid and current for each reference.
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:*
Thank you for applying with 4-H CAPITAL. Please click Submit to complete your application.

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4-H CAPITAL AmeriCorps Instructor Application

Step 1 of 8

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

SKILLS AND EXPERIENCE

SKILLS

CERTIFICATIONS

LANGUAGES

EMPLOYMENT HISTORY

Position 1

Position 2

Position 3

Position 4

Employment Gaps or No History

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 HISTORY QUESTIONNAIRE

DEMOGRAPHIC INFORMATION

REFERENCES

Reference 1

Reference 2

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