Civic Service Institute, Northern Arizona University

Youth in Action AmeriCorps

Civic Service Institute, Northern Arizona University

PO Box 6025, Flagstaff, AZ 86001

Phone: (928) 523-6395 / Fax: (928) 523-9189

nau.edu/americorps

Member Application Part Two

Directions: Application Part Two should be completed after you have completed the online application here:

Qualified individuals with disabilities and those from diverse backgrounds are strongly encouraged to apply. We provide reasonable accommodations for qualified individuals upon request.

Applicant Name:

Minimum Qualifications:

I am a U.S. Citizen, National or Permanent Resident Alien who can legally work in the United States

I will be at least 18 years old by August 31, 2016

I have or will obtain a high school diploma or the equivalent before using the Segal Education Award

AmeriCorps Commitments:

If accepted as an AmeriCorps Member, I understand that I am committing to a total of 300, 450, 900, or 1700 hours, to be completed by 08/31/2016.

If accepted as an AmeriCorps Member, I understand that as a condition of service, I will have a FBI fingerprinted background check and a National Sex Offender Registry search conducted prior to beginning service. Some positions or situations may require additional screening.

If accepted as an AmeriCorps Member, I will attend the mandatory orientation, training, and Esprit de Corps events. I understand that if I do not attend these events, I may be negatively exited from the program.

Previous AmeriCorps Experience

Have you ever served in AmeriCorps before? Yes No If yes, please complete the following section:

Program Name:

Program Location:

Dates Served:

Did you successfully complete your AmeriCorps service? Yes No If not, why?

Member Application Part Two

NAU AmeriCorps is federally funded and we must abide by the regulations governing national service programs. In order to apply, you must be 1) a United States citizen, national, or lawful permanent resident alien of the United States, 2) at least 17 years old at the start of your term, and 3) have obtained the equivalent of a high school diploma before using your Segal Education Award.

Required Documentation

In order to prove that you are a citizen, national or lawful permanent resident, please provide a copy of one of the following:

Copy of birth certificate

Copy of passport

Copy of Permanent Resident Card or Alien Registration Receipt Card

In order for us to complete I-9 verification that shows that you are legal to work in the United States, please bring to our office, either:

United States passportAND Social Security Card

OR

Government issued picture identification or Resident Alien Card

ANDSocial Security Card

In order to verify your age, please provide a copy of one of the following:

Government issued picture identification (i.e. drivers license or passport) or Resident Alien Card

Copy of birth certificate

By signing this application, you are authorizing a state criminal registry check, FBI fingerprint check, and the appropriate sharing of the results of such checks within our program. Selection for an AmeriCorps position is contingent upon NAU AmeriCorps’ review of your criminal history, in any. To understand NAU’s policy regarding background checks, review NAU HR policy 1.085.

Member Application Part Two

Directions: Please check the boxes below to indicate your skills, interests, abilities, and availability. This section will be used to help find a position that is a good fit for you. Please check all that apply.

Skills / Interests / Abilities and Availability
First Aid Certification
Web page design
Graphic design
Public speaking
Writing
Marketing (including social media)
Project management
Fluent in Spanish
Fluent in Navajo
Clerical (filing, copying, faxing)
Food service
Customer service
Child care
Counseling and/or social work
4-wheel driving
Coordinating volunteers
Tutoring and/or advising
Teaching groups of children
Accounting
Use a computer (PC)
Use a computer (MAC)
Use Microsoft Word to create fliers
Enter data using Microsoft Excel
Use Microsoft Powerpoint to make presentations
Strong math skills
Experience working with people with disabilities
Experience working with diverse populations
Other ______
Other ______
Other ______/ Working with elementary school age children
Working with teenagers
Working with senior adults
Supervising others
Small business
Native American culture
Native plants
Sustainability and/or conservation
Affordable housing
Domestic violence
Human rights
Public health
College access
Education
Adult literacy
Local history
Other ______Other ______
Other ______/ Have reliable transportation
Have an Arizona Driver’s License
Have a good driving record
Available all year long (including December and summer)
Available on weekdays
Available in the evenings
Available on weekends
Ability to work outside all day in all weather conditions
Available to travel for extended (10 days or more) assignments out of the local area
Ability to do physically strenuous work that includes lifting, bending, digging, etc.
Ability to stand for extended periods of time
Ability to lift 50 lbs
Self-motivated
Ability to work independently
Ability to work in a team
Can work with sensitive data/confidential files
Other ______
Other ______
Other ______

Member Application Part Two

Community Focus Areas

Please rank the community focus areas with 1 being the area you are most interested in and 5 being the area you are least interested in.

Youth Engagement in Service Learning and Leadership

Post High School Advising

Job Placement & Employment Opportunity

Financial Literacy

GED Program Development

Additional Questions

What are your expectations of AmeriCorps?

Are you currently registered to attend classes at NAU? Yes No

Are you currently registered to attend classes at CCC? Yes No

How did you hear about NAU AmeriCorps?

Certification

Directions: Your application must be certified with an original signature. Read the statement carefully before signing. Unsigned applications and incomplete applications will not be considered for admission.

I certify that all 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 the information provided herein may be used to process my application for acceptance into NAU AmeriCorps and for other general routine purposes by local programs and/or the Corporation for National Service, and it will not be disclosed outside of these entities without prior written permission.

______

SignatureDate

1