Serve Louisiana AmeriCorps Member Application 24-25 Service Term

Serve Louisiana AmeriCorps Member

COMMUNITY INVOLVEMENT

EDUCATION HISTORY

CONTACT INFORMATION

Eligibility Requirements

ADDITIONAL INFORMATION (OPTIONAL)

EMPLOYMENT HISTORY

LOCATION AND ORGANIZATIONS OF INTEREST

MOTIVATIONAL STATEMENTS

CERTIFICATION

National Service Criminal History Consent Form

Serve Louisiana AmeriCorps Member

September 1, 2024- July 31, 2025
CONTACT INFORMATION
First Name
Middle Initial
Last Name
Pronouns

Other
Email Address
example@example.com
Phone Number
Current Address

Street Address

Street Address Line 2

City, State Zip CodeState / Province

Postal / Zip Code
Permanent Address

Street Address

Street Address Line 2

City, State Zip CodeState / Province

Postal / Zip Code
How did you find Serve Louisiana?
Eligibility Requirements

Please read the following questions carefully. If you are not sure whether or not you are eligible to serve, please email maggie@servelouisiana.org office with any questions.
1. You must be a US citizen, US national or Permanent Legal Resident to join Serve Louisiana. Please confirm that one of these designations describe your citizenship status.
2. Have you ever APPLIED to AmeriCorps or Serve Louisiana (previously known as Louisiana Delta Service Corps)? If no, skip to question 5.
3. Have you ever INTERVIEWED for AmeriCorps or for Serve Louisiana?
4. Have you ever SERVED in AmeriCorps or Serve Louisiana?
If yes, give service dates and name of corps:
5. Since Serve Louisiana members must serve 40 hours per week and attend all team meetings, service projects, and retreats, this service program is not fitting for any full-time students. Any part-time students applying will be accepted on a case-by-case basis. Do you plan to be a student at any point during the 2024-2025 Service Term?
6. Serve Louisiana members will receive a modest living allowance of $2,181 per month (before taxes). Would this allow you to meet your financial obligations?
7. The Serve Louisiana service term is September 1st - July 31st. Can you commit to serve full-time for the 11 months?
8. Serve Louisiana members must attend Serve Louisiana programming including monthly meetings and 3-Day overnight personal and professional development trainings. Can you commit to this requirement?
9. Serve Louisiana members will receive an education award of $7,395 which can be used towards student loans or future educations. Do you have a use for an education award ?
10. Serve Louisiana members commit to serving full-time at a partner organization (40 hours/ week). Can you fulfill this commitment?
11. Do you have reliable transportation?
12. Serve Louisiana members must consent to a criminal background check. See the consent form at end of the application for more information on disqualifying criminal convictions. Will you agree to a criminal background check?
13. Serve Louisiana members must be at least seventeen years of age. Do you meet this requirement?
14. Serve Louisiana members must have at least a high school diploma or G.E.D. Do you meet this requirement?
ADDITIONAL INFORMATION (OPTIONAL)

In compliance with federal civil rights laws, these questions are optional.Your responses will remain confidential.
Gender you identify with :

Other
Date or Birth

MonthDayYear
Date
Categories that describe you:
EMPLOYMENT HISTORY

List employers and jobs starting with the most recent:

COMMUNITY INVOLVEMENT

List any community, social, faith-based, neighborhood, or professional projects and programs where you have served:

Rows	Organization	Description of volunteer activities	Dates active	Point person and contact information

EDUCATION HISTORY

List schools attended, beginning with most recent:

Rows	School and location	Area of Study	Degree and date achieved	Dates attended

Select All Preferred Positions:
Select All Preferred Fields of Service:
LOCATION AND ORGANIZATIONS OF INTEREST
List cities and organizations where you would like to serve:
List any skills, interests, and hobbies including anything relevant to the positions:
Employee Reference and contact information
Community Reference and contact information
Can be a community member, teacher, volunteer supervisor, faith-based leader, etc.
MOTIVATIONAL STATEMENTS

Please note that your responses in this section also serve as your writing samples. We encourage you to answer these questions thoughtfully, and be sure to proofread.
1. Why do you want to become a Serve Louisiana/AmeriCorps member?

0/500
2. We believe that we can learn from each other's experiences and that real change is possible when people work across differences toward a common goal. We prioritize guiding principles of open-mindedness, responsibility, and wholeheartedness in our program. Describe an experience you had working others who were different from yourself or share any thoughts you have on these guiding principles.

0/500
3. Serve Louisiana members earn a modest living allowance. How do you anticipate this will affect you during the course of the year?

0/500
4. Serve Louisiana involves corps members in the goal setting, planning, and facilitation of the monthly personal and professional development meetings. Why are you interested in developing as a leader?

0/500
5. What are your long-term goals, and how do you see a year with Serve Louisiana helping you to achieve them?

0/500
6. What does it mean to do good work?

0/500
CERTIFICATION
I certify that all of the statements made in this application are true, correct, and complete, to the best of my knowledge, and are made in good faith. I understand that misinformation or omission of information could result in disqualification and/or termination as an AmeriCorps member. I also understand that my selection for participation in some AmeriCorps programs may require drug testing. Background and security checks may also be conducted by some programs. PRIVACY ACT NOTICE: The Privacy Act of 1974 (5 U.S.C § 552a) requires that the following notice be provided to you: The authority for collecting information from you in this application is contained in 42 U.S.C 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C 4953 of the Domestic Volunteer Service Act of 1973 as amended. You are advised that submission of the information is entirely voluntary, but the requested information is required in order for you to participate in AmeriCorps programs. By signing below, I give the Corps permission to conduct a record check. Completion of this application does not guarantee an interview or position with AmeriCorps/Serve Louisiana.
Name
Signature
Date

MonthDayYear
Date
National Service Criminal History Consent Form
I, agree to undergo the National Service Criminal History Check, which may include one or both of the following: Checks of state criminal history registries for locations where I’ve lived as well as where I will serve or work and/or an FBI fingerprint check. I also understand that acceptance into Serve Louisiana is subject to check results and that a candidate can be disqualified for any one of the following reasons: 1. Murder conviction 2. Required to be registered on a sex offender registry 3. False statement in response to inquiry about criminal history 4. Refusal to undergo the National Service Criminal History Check
I understand that I may review and challenge the factual accuracy of the results before action is taken to exclude me from the program. I understand that I will not assume the cost of performing any part of the three-part background check.
Name
Signature
Date

MonthDayYear
Date
Should be Empty:

Place of Employment

Position/Title

Dates of Employment

Reason for Leaving

Point person and contact information