AmeriCorps College Member Application (HT) Thank you for your interest in the AmeriCorps Program.

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1 AmeriCorps College Member Application (HT) Thank you for your interest in the AmeriCorps Program. Requirements for applicants: Must be at least 17 years old on August 18, 2014 Must attend AC or WTAMU for the school year Must have 48 college hours (official transcript) or pass No Child Left Behind Test Must be a legal resident of the United States Must have own transportation Must be able to manage groups of children ages 5-12 in an instructional setting Must be able to follow directions from supervisors Must track students for reporting purposes Scheduling: Must have room in schedule to work in an Extended School Day Program between the hours of 12:00 noon and 6:30 pm Must attend required training sessions and classroom observations Must participate in required National Service Days, projects, and trainings Benefits of being in AmeriCorps are: $9,000 living allowance $2,775 educational allotment after successful completion of the program and a minimum of 900 service hours Excellent job experience The timeline for filling the 10 openings for is: Applications must be turned in to Jill Humphrey by March 7, 2014 (AISD ESC Building, 7200 I-40 West, 79106) Interviews will be held at Amarillo ISD Education Support Center in April. Applicants will be notified of the date of the interview. Candidates accepted into AmeriCorps for will be notified in writing. Questions? Please call Jill Humphrey at ***Applications must be accompanied by proof of education (High school diploma or college transcript), a copy of your Social Security card and a valid driver s license or state-issued identification card*** Experience working with children in a school setting is preferred. All personnel of the Amarillo ISD shall be employed without regard to race, color, religion, age, sex, national origin, or disability. Persons with disabilities are encouraged to apply for these positions.

2 Amarillo ISD AmeriCorps Application for Half-Time Service Picture of applicant must be attached in this space. To be completed by applicant: Legal Name Only Last Name First Name Middle Name Street Address City State Zip Code Telephone Number (cell preferred) Age Date of Birth Social Security # Current High School/College: Classification (circle one) freshman sophomore junior senior References List 3 persons, not related to you, who are acquainted with your working ability and experience. Name Position Complete Address Zip Home/Work Phone Hm Wk Hm Wk Hm Wk I certify that the information contained in this application is true and complete. I understand and agree that any false or incomplete information provided by me will be good and lawful cause for either: (1) refusal to employ me; or (2) discharge or termination. I authorize Amarillo Independent School District to investigate all statements contained herein, to investigate all information concerning my previous employment, and to contact all references listed on the application. I authorize any person or legal entity contacted by AISD to release any information about me upon the request of AISD. I hereby release all parties providing information to AISD from all liability for any damage that may result from furnishing that information. I agree that all information obtained by AISD from any person or legal entity about me shall remain confidential and not be made available to me. I authorize AISD to obtain my criminal history record, if any, from any source. I further authorize any law enforcement agency, including but not limited to any police department or the Texas Dept. of Public Safety, as well as the Texas Dept. of Corrections, to furnish AISD any such criminal history record. I hereby release, discharge, and agree to hold harmless AISD, its agents, employees, trustees, and representatives, of and from any and all liability which might arise from any investigation of me in connection with my application for employment or employment with AISD. Date Applicant s Signature Date Parent s Signature if applicant is under 18 yrs. By signing this document, I (we) do give permission for our child to apply for and participate in, if chosen, the AISD AmeriCorps Program. All personnel of the Amarillo ISD shall be employed without regard to race, color, religion, age, sex, national origin, or disability. 01/07.

3 PERSONAL DATA 1. Have you been convicted of any criminal offense other than a traffic violation in this state, in any other state, or in any other country? ( )Yes ( )No 2. Have you ever received probation or deferred adjudication of guilt for any criminal offense other than traffic violation in this state, in any other state, or in any other county? ( )Yes ( )No 3. If you answer yes to any of the above questions, please provide an explanation. This includes date, charge, and location of the applicable court or tribunal. CONVICTION OF A CRIME IS NOT AN ABSOLUTE BAR TO PARTICIPATION. THE DISTRICT WILL CONSIDER THE NATURE, DATE, AND RELATIONSHIP BETWEEN THE OFFENSE AND THE POSITION FOR WHICH YOU ARE APPLYING. 4. Are you a U.S. citizen? ( )Yes ( )No If no, enter: Alien Reg. No. Date Filed 5. Are you currently employed? ( )Yes ( )No If yes, enter employer: 6. Can you perform the essential duties and functions of the job for which you have applied? (See Position Description attached) ( )Yes ( )No If no, please explain what accommodations would be needed for you to perform the essential functions of the job. 8. AmeriCorps requires that all members have reliable transportation. Do you have your own transportation? ( )Yes ( )No EXPERIENCE WITH CHILDREN 1. Have you worked with children in any capacity? ( )Yes ( )No If yes, please explain where this occurred and briefly describe your responsibilities in this situation: Briefly describe your plans when you graduate from college. Why do you want to be a member of AmeriCorps? Have you ever served in a National Service Program AmeriCorps VISTA, AmeriCorps NCCC? Yes No Position held Dates of involvement: From To Supervisor Phone

4 Educational Background Circle the most current: Currently enrolled in high school Technical school/apprenticeship Associate s degree High School Diploma Some college Bachelor s degree Last school Attended: Name Dates of attendance: From To Are you employed? Yes No If no, have you ever been employed? Yes No List work experience. From To Position Company Reason for leaving Supervisor Phone How could you contribute to the Amarillo ISD AmeriCorps program? What do you hope to gain? How would this experience advance your personal and professional goals?

5 NATIONAL SERVICE CRIMINAL HISTORY CHECK (NSCHC) CONSENT & VERIFICATION FORM I,,* agree to the following Criminal History Checks to be performed in order to serve as an AmeriCorps Member or work as an employee with Amarillo ISD AmeriCorps Program: NSOPW Public Sex Offender Check Statewide Repository Checks (for State of Service and State of Residence) FBI fingerprint-based Check I am aware that that my identity must be verified with a government issued photo ID. I understand that the results of these checks will be kept confidential, but could affect my eligibility to serve in AmeriCorps or work as staff with Amarillo ISD AmeriCorps Program. I am aware that I have the right to review the findings. *Please include any aliases or names previously used such as maiden names: Applicant Signature Date Parent Signature if applicant is under 18 Bottom portion to be completed by program staff. Staff should initial after searches have been initiated or completed. 1. CRIMINAL HISTORY CHECK #1 National Sex Offender Public Website Check (Must initiate and complete prior to start of service or work.) 2. CRIMINAL HISTORY CHECK #2 Statewide Repository Checks (Must initiate no later than start of service or work) STATE OF SERVICE: Texas Repository Checked: TX-DPS Public Site (Name-based) TX-DPS Secure Site (Fingerprint-based) Other: STATE OF RESIDENCE (if other than Texas at the time of application): Name of Repository Checked: CNCS-Designated Repository? Y / N 3. CRIMINAL HISTORY CHECK #3 FBI fingerprint-based Check if member will have recurring access to vulnerable populations. (Must initiate no later than start of service or work) Identity has been verified by government issued photo ID. Staff Initial Based on the results of the National Service Criminal History Checks listed above: The individual has been deemed eligible to serve in/work with Amarillo ISD AmeriCorps Program. The individual has been deemed ineligible to serve in/work with Amarillo ISD AmeriCorps Program. I also certify that the results of these checks have been kept confidential, that the program has paid for the checks, and that we have allowed the individual the opportunity to review any findings from the checks. Authorized Program Staff Signature Date Individual Deemed Eligible/Ineligible to Serve

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