PERSONAL PROFILE

* Applicant Name

* Are you a United States citizen, national, or lawful permanent resident alien?

If you are a lawful permanent resident alien and you received your card after January 1987, what is your registration number and card expiration date?

* Date of Birth

You must be at least 18 years of age and out of high school to apply for YA AmeriCorps.

* Gender

* City of Birth

* State of Birth

Country of Birth

Will you be available to begin service on September 1, 2008?

* What type of position would you prefer?

Contact Information:

* Email Address

Mobile Phone Number

Home Phone Number

Work Phone Number

Current Address:

* Street Address

* City

* State

Alternate Email Address

* What is your current form of transportation?

EDUCATION

* Level of education you will have completed by September 1, 2008

List all schools after high school that you have attended,including trade or technical schools,
military training, and employment training programs.

	Name of School or Program	City and State	Dates of Attendance	Date you graduated or will graduate/complete program
1.
2.
3.

YA AmeriCorps 2008-2009 members may attend college classes until 12 noon Monday through Friday.
Members must be available to begin their service by 1:00 p.m. each day.

COMMUNITY SERVICE

* Describe how you have reached out to help others and/or how you have been involved in your own community. Elaborate on why you decided to serve or get involved, and what you received in return—that is, what you learned or how it made you feel. Think in broad terms.

Please list previous community service experiences you have had. Be as specific as possible.

	Organization Name	Month & Year(s) of Service	Hours per Month Served	Description of Service
1.
2.
3.

* Have you previously served in AmeriCorps?

Name of previous AmeriCorps program

Dates of Previous AmeriCorps Service

Did you complete your term of service?

If not, please explain.

EMPLOYMENT HISTORY

List and briefly describe the last four positions you have held. Include self-employment, internships
or fellowships, home management, and full- or part-time paid or unpaid work experience.

	Company/Organization Name	Dates of Employment	Job Responsibilities	Reason for Leaving
1.
2.
3.
4.

Explain any gap in your employment history of greater than six months that is not accounted for by work, school, or military service.

MOTIVATIONAL STATEMENT

* Why do you want to join AmeriCorps? What could you contribute to YA during your AmeriCorps service? What do you hope to gain from serving as an AmeriCorps member?

LEGAL

Answer the following questions fully. Existence of criminal conviction/adjudication may or may not, depending on the circumstances, disqualify you from consideration. However, any intentional misrepresentation or omission will disqualify you. Do not include traffic violations.

* Have you ever been convicted of any criminal offense by either a civilian or military court (not including traffic violations)?

* Do you have any criminal charges pending against you in any jurisdiction in the United States?

* Are you currently on probation or parole?

If you answered yes to any of the questions above, please explain the charges you face(d) and the court action taken.

SKILLS AND EXPERIENCE

Listed below are skill areas that YA AmeriCorps finds useful in applicants for the program. Indicate the skill areas in which you have had training or experience, including volunteer or community service experience, and indicate how you gained those skills.

Business/Entrepreneur

Communications

Community Organization/Development

Computers/Technology

Conflict Resolution

Counseling

Education

Fine Arts/Crafts

First Aid

Fundraising

Leadership

Public Speaking

Recruitment

Teaching/Tutoring

Writing/Editing

Youth Development

Other (please specify)

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

Language(s)

* Please evaluate your fluency in language other than English.

Please provide any additional skills and experience that may be helpful in evaluating your application.

CERTIFICATION

* I hereby certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any information I have given here or that I have left out could result in an unfavorable consideration of this application. I agree to allow release of this information for verification and evaluation purposes. I understand that YA is a drug and alcohol-free and smoke-free workplace.

* Please print your name to certify your application.

* Today's Date

NON-DISCRIMATION POLICY: The Youth Advocates AmeriCorps program does not discriminate on the basis of race, color, national origin, disability, age, sex, political affiliation, religion, or sexual orientation. This material is based upon work supported by the Corporation for National Service and One Star Foundation. Opinions or points of view expressed in this document are those of the authors and do not necessarily reflect the official position of, or a position that is endorsed by, the Corporation, One Star Foundation or the AmeriCorps Program.

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