An Equal Opportunity Employer
                                                    Application for AmeriCorps Positions 

 

Thank you for your interest in EducationWorks.

Please complete the application in full, including essays. Incomplete applications
will not be reviewed.

PERSONAL INFORMATION
Last Name:
 First Name:
 Middle Initial:
 Social Security Number:
XXX - XX -
Present Address:
 Apartment Number:
City:
 State:
 Zip:
- 		Phone:
Are you interested in:
Full Time         Part Time 		What is the earliest date you can start :
What program or type of position are you applying for?
Dates if you have worked for EducationWorks previously:
From:    To:      What was the position:
How did you learn about EducationWorks?
Are you eligible for employment in the United States?
Yes    No 		Do you have a valid driver's license?
Yes   No
EDUCATION
Name of School City and State Years Attended Major Studies Degree/Diploma Granted
High School (last attended) City:
State:
 From:

To:
  
GED
 City:
State:
 From:

To:
  
College (last attended)
 City:
State:
 From:

To:
Graduate School (all attended)
 City:
State:
 From:

To:
Others (last attended)
 City:
State:
 From:

To:
Foreign Languages:
Speak?
 Read?
Write?
FORMER EMPLOYERS (List below last three former employers, starting with the most recent one first.)
Name of present or last employer
Address1:
 Address2:
City
 State:
 Zip:
  
Job Title:
 Start Date:
 Leave Date:
  
May we contact your supervisor?
Yes         No 		Starting Weekly Salary:
 Final Weekly Salary:
  
Name of Supervisor:
 Title:
 Phone:
Description of Work:
Reason for Leaving:
Name of previous employer
Address1:
 Address2:
City
 State:
 Zip:
  
Job Title:
 Start Date:
 Leave Date:
  
May we contact your supervisor?
Yes         No 		Starting Weekly Salary:
 Final Weekly Salary:
  
Name of Supervisor:
 Title:
 Phone:
Description of Work:
Reason for Leaving:
Name of previous employer
Address1:
 Address2:
City
 State:
 Zip:
  
Job Title:
 Start Date:
 Leave Date:
  
May we contact your supervisor?
Yes         No 		Starting Weekly Salary:
 Final Weekly Salary:
  
Name of Supervisor:
 Title:
 Phone:
Description of Work:
Reason for Leaving:
COMMUNITY INVOLVEMENT
Have you participated in an AmeriCorps program, other community service program, or done volunteer work? If yes, list program name, describe the type of service or volunteer work and include the dates of service.
Program Name Dates Type of Service

SKILLS
Please list any special skills or experience you may have relevant to the position(s) for which you are applying.

LEGAL - Only applicants for New Jersey programs should complete this section. Applicants for Pennsylvania sites will complete this information at their interview.

EducationWorks will check all AmeriCorps members for a criminal background and history of child abuse. Depending on the circumstances, the existence of a criminal record or an indication of child abuse may disqualify you from consideration. If you have been arrested or investigated for child abuse or investigated for a crime you do not reveal,  you may be disqualified or dismissed from EducationWorks, regardless of the circumstances.

Criminal History

1. Have you ever been arrested? YES NO
2. Have you ever been convicted of a crime? YES NO
3. Have you ever pled guilty to a crime? YES   NO  
4. Have you ever pled no contest to a crime? YES NO
5. Have charges against you ever been dealt with in some other way? YES   NO  
6. Are there any pending charges against you? YES NO
7. Are you being investigated now for any reason? YES   NO  
If you answered yes to questions #1-6, please answer the following:
Why were you arrested?
When were you arrested?
Where were you arrested?
If you answered yes to question #7, please explain:
Are you now on probation or parole?  YES   NO  
If yes, provide the name, address, and phone number of the judge, probation officer or parole officer. Name:

Address:

 Phone:
Child Abuse History
1. Have you ever been investigated for child abuse? YES      NO      
2. Have you ever been found to be engaged in child abuse? YES      NO    
If you answered yes to questions #1 and/or #2, please explain:


PERSONAL
Date of Birth (MM/DD/YY):
Sex:  Male   Female     
Are you a citizen of the United States?     Yes No If no, are you a permanent resident alien?        Yes   No
If accepted as an AmeriCorps member, do you plan to be enrolled in an undergraduate or graduate program during your term of service?
    Yes      No
If yes, please provide the following information:
College Name:
  City:
 State:
  
Major/ Program of Study:

 Expected Date of Completion:
 Expected Number of Credits per Semester:   
If accepted as an AmeriCorps member do you plan to hold a job during your term of service?
  Yes     No
If yes, what kind of work schedule would this involve? (Please include hours per week and work schedule)

PERSONAL ESSAY
Please write two essays, which respond to two of the three questions listed. The essays should be a minimum of 100 words each. Feel free to add any additional information about yourself that you feel we ought to consider.

1. Why do you want to join EducationWorks?
2. How do you feel your life experiences will help you in facing this position?
3. What do you think are the most serious problems facing urban schools and communities, and why?

PERSONAL REFERENCES
If you are unable to provide employee references or choose to supplement your employment references, please provide the names, addresses and phone numbers of two people to serve as personal references. They should be able to speak about your capabilities and personal character. They may not be immediate family members or relatives.

Reference #1

Name:

Organization:

Title:
Street Address:
City:
State:
Home Phone:
 (please include area code)
Business Phone:
 (please include area code)
Reference #2  

Name:

Organization:

Title:
Street Address:
City:
State:
Home Phone:
 (please include area code)
Business Phone:
 (please include area code)


I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION AND OTHER DOCUMENTS OR RESUMES SUBMITTED ARE TRUE AND COMPLETE. I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION WILL BE GROUNDS FOR NOT HIRING AN APPLICANT OR FOR IMMEDIATE TERMINATION IF EMPLOYED.

I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED INCLUDING CRIMINAL BACKGROUND AND HISTORY OF CHILD ABUSE AND, IF ACCEPTED, A CHECK OF CRIMINAL AND CHILD ABUSE RECORDS.  I UNDERSTAND I WILL BE INFORMED OF ANY FINDINGS WHICH MAY IMPACT MY APPLICATION AND PARTICIPATION, AND I MAY REVIEW AND CHALLENGE THE FACTUAL ACCURACY OF BACKGROUND CHECK RESULTS.

I RELEASE EDUCATIONWORKS AND THE EMPLOYERS LISTED ABOVE AND ANY REFERENCES I PROVIDE FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT WHICH MAY BE DISCLOSED TO EDUCATIONWORKS.

 
NAME OF APPLICANT:
  		 DATE:
   		E-MAIL ADDRESS: