13. List all schools after high school that you have attended, including trade or technical schools, military training and employment training programs. (List the most recent first)
14. Beginning with the most recent position, list and briefly describe the last four positions you have held or your last ten years of employment you have held.
You may attach a resume instead if it addresses the information requested below.
(Preference will be given to candidates with previous experience.)
16. Describe your experience working with youth. List your most recent activity first. Your experience does not have to be limited to a professional environment. For instance, you could list babysitting, teaching Sunday School, or helping to raise siblings.
Dates of Invovlement:
(Previous service is not always a requirement.)
16. Describe how you have reached out to help others and/or you have been involved in your own community. List your most recent activity first. Your involvement could include serving in the neighborhood, school, religious, social, professional, or other volunteer groups; helping out with the community service projects; or participating in less formal activities.
How many times in each of these programs?
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 crime that would have a direct bearing on your service.
This background check will entail our search of the National Sex Offenders Registry and an FBI criminal history check, which will require you to be fingerprinted during Pre-Service Orientation.
You will not be permitted to begin serving without supervision until the history check is complete and you are cleared. If you are selected for further consideration, you will be given clearance applications and instructions at that time.
Applicant please read and check off the following statements:
As an applicant for an AmeriCorps member position, I understand and acknowledge that my acceptance as an
AmeriCorps member in the KEYS Service Corps AmeriCorps program is subject to the results of each of the following National Service criminal history elements:
Criminal History Barring Service with the KEYS Service Corps
Permanent Bars to KEYS AmeriCorps Service
Criminal History Barring Service with the KEYS Service Corps at School Host Sites
KEYS Service Corps AmeriCorps members serving at schools are bound by the additional restrictions as set forth by the Pennsylvania Department of Education. So in addition to the AmeriCorps statutes barring enrollment and of the other permanent bars above, the following offenses with convictions will also bar service at a school site.
In addition to the above permanent bars to school employment, Section 111(f.1) of the Pennsylvania School Code, 24 P.S. § 1-111(f.1), contains three provisions describing temporary bars including:
A. Under Section 1-111(f.1) (1) of the Pennsylvania School Code, if an individual is convicted of a felony offense of the first, second or third degree, other than those listed in Section 1-111(e), he will be barred from employment in Pennsylvania schools for ten years following the expiration of his sentence.
B. Under Section 1-111(f.1)(2) of the Pennsylvania School Code, if an individual is convicted of a misdemeanor of the first degree, he will be barred from employment in Pennsylvania schools for five years following the expiration of his sentence.
C. Under Section 1-111(f.1)(3) of the Pennsylvania School Code, if an individual is convicted more than once for driving under the influence of alcohol or a controlled substance, and the offense is graded as a first degree misdemeanor, he will be barred from employment in Pennsylvania schools for three years following the expiration of his sentence. The Corporation for National and Community Service programs are available to all without regard to race, color, national origin, disability, age, gender, sexual orientation, religion, political affiliation, or other non-merit factors. Anyone believing he or she has been subjected to discrimination on these grounds by the Corporation for National and Community Service, AmeriCorps, or one of its grantees may contact our Office of Civil Rights and Inclusiveness at (202) 606-7503 or email at email@example.com.
If you choose to submit a paper application, your application must be certified with your original signature in ink.
By signing this application, or by submitting it electronically if applying on-line, 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. Misinformation or omission of information could result in disqualification or termination as an AmeriCorps member. If I am selected for participation in KEYS Service Corps, I may be required to submit to a physical examination, including drug or alcohol testing.
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.
The principal purpose for requesting this personal information is to process your application for acceptance into an AmeriCorps program, and for other general routine purposes associated with your participation in an AmeriCorps program. These routine purposes may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests, to present and former employers, references provided by you in your application, and educational institutions, for the purpose of verifying the information provided by you in your application. In some programs, the information may also be provided to federal, state, and local law enforcement agencies to determine the existence of any prior criminal convictions. The information will not otherwise be disclosed to entities outside of AmeriCorps and the Corporation for National and Community Service without your prior written permission.