AmeriCorps Application
Name and Address
First Name
*
Last Name
*
Phone Number
*
Email
*
If under 18, please list age
Mailing Street Address
*
City
*
State
*
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Non-US
Zip
*
Job Type
Days Available to Work
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
I am seeking a
*
Full-Time job
Part-Time job
How many hours can you work weekly?
*
Can you work nights?
*
Yes
No
Date available to begin
*
Additional Information
Have you ever been employed by AIM in the past?
*
Yes
No
I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States.
*
Yes
No
Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony?
*
Yes
No
If Yes, please explain:
Do you have a driver's license?
*
Yes
No
License number
State Issued
*
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
How many accidents have you had in the last three years?
How many moving violations have you had in the last three years?
Education
Highschool
1
Highschool Name
Years Completed
Highschool Address
Major
Degree or Diploma
Select One
High highschool Diploma or Equivalent
Professional Certificate
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
MD
JD
2
Highschool Name
Years Completed
Highschool Address
Major
Degree or Diploma
Select One
High highschool Diploma or Equivalent
Professional Certificate
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
MD
JD
College or Business/Trade School
1
School Name
Years Completed
School Address
Major
Degree or Diploma
Select One
High school Diploma or Equivalent
Professional Certificate
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
MD
JD
2
School Name
Years Completed
School Address
Major
Degree or Diploma
Select One
High school Diploma or Equivalent
Professional Certificate
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
MD
JD
3
School Name
Years Completed
School Address
Major
Degree or Diploma
Select One
High school Diploma or Equivalent
Professional Certificate
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
MD
JD
4
School Name
Years Completed
School Address
Major
Degree or Diploma
Select One
High school Diploma or Equivalent
Professional Certificate
Associate's Degree
Bachelor's Degree
Master's Degree
PhD
MD
JD
Military
Have you ever been in the Armed Forces?
*
Yes
No
Date entered
Are you now a member of the National Guard?
*
Yes
No
Discharge Date
Specialty
Work Experience
1
Company
Address
City, State, ZIP
Job Title
Hours per Week
Start Date
End Date
Start Salary
Final Salary
Reason for Leaving
Duties
Supervisor Name
Phone Number
May we contact this employer?
Yes
No
2
Company
Address
City, State, ZIP
Job Title
Hours per Week
Start Date
End Date
Start Salary
Final Salary
Reason for Leaving
Duties
Supervisor Name
Phone Number
May we contact this employer?
Yes
No
3
Company
Address
City, State, ZIP
Job Title
Hours per Week
Start Date
End Date
Start Salary
Final Salary
Reason for Leaving
Duties
Supervisor Name
Phone Number
May we contact this employer?
Yes
No
4
Company
Address
City, State, ZIP
Job Title
Hours per Week
Start Date
End Date
Start Salary
Final Salary
Reason for Leaving
Duties
Supervisor Name
Phone Number
May we contact this employer?
Yes
No
References
1
Name
Phone Number
Relation to Applicant
2
Name
Phone Number
Relation to Applicant
3
Name
Phone Number
Relation to Applicant
4
Name
Phone Number
Relation to Applicant
Submit