C.O.R.E. Susquehanna Americorps Application |
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713 Bridge St. Suite 10
Selinsgrove, PA 17870
Phone: (570) 374-8938
Fax: (570) 374-6144
www.coresusquehanna.org
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Please complete the entire application and press SEND IT. If you do not wish to fill out the application
online you may copy and paste the application and fill it out by hand. Both pages must be filled out in full;
you may include a resumé with attachments and return them to the address listed above.
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| First Name: Last Name: |
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Date of birth (mm/dd/yyyy): |
Current Address:
Line 1:
Line 2: (Apt #, etc)
City: State: Zip:
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Home Phone:
Cell Phone:
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Email Address: |
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Are you a U.S. Citizen or Permanent Resident Alien?
YES
NO
Do you have a current driver's license?
YES
NO
Do you have personal transportation?
YES
NO
Are you interested in part-time or full-time?
Full-Time
Part-Time
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PERSONAL STATEMENT
Please prepare a personal statement in which you address:
1. Why you wish to join AmeriCorps.
2. What skills or experiences will most help you to contribute to the program.
3. A description of your community service experience. Include social, school, professional and neighborhood projects.
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SKILLS
Please indicate areas in which you have had significant training or experience
which resulted in working knowledge or a high level of performance.
Check all
that apply.
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Computers
Counseling
Child Care/Development
Health/Nursing
Communications/Journalism
Community Outreach/Organizing
Mediation/Conflict Resolution
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Public Speaking
Social Services
Teaching/Tutoring
Youth Work/Coaching
Victim Assistance
Foreign Language, please specify
Other, please specify
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EDUCATION
Beginning with the most recent, please list all schools attended including high school,
trade or technical school, college or university.
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Previous Experience
Have you previously served with AmeriCorps?
YES
NO
If so, when? (mm/dd/yyyy)
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Criminal Record
Have you been convicted of any criminal offenses?
YES
NO
If so, are you facing any current charges?
YES
NO
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