2023-2024 CitySquare AmeriCorps Member Application

Page 1

Thanks for your interest in serving with CitySquare AmeriCorps; complete this application and press "Send" to submit.

I. Application Cover Sheet

Applicant Name:

Member Requirements:

Applicants must meet all of the following criteria in order to be eligible to apply.

17 years old or older
U.S. Citizen or Permanent Resident (Deferred Action or Temporary Permanent Resident does not qualify)
Commitment to serve the community

This service opportunity is highly interpersonal and requires that members serve well with others and accommodate diverse points of view. In return for service, members receive a twice monthly living allowance and end of term education award.

Program Preferences | Select all that apply:

Education

Serve with one of CitySquare's community partner agencies (host sites) in a structured after-school or summer program to provide daily enrichment activities and increase social emotional skills for youth in low-income areas. Host sites are located in various neighborhoods in Dallas.

Select which term of service you are interested in serving in:

Summer Programs | June 3, 2024 - August 2, 2024

Social Services

Serve with CitySquare programs and other nonprofit organizations to provide social service assistance to vulnerable individuals and families through case management, housing support, homeless outreach, workforce training, etc. Preference for these positions is given to applicants pursuing a degree in social work or a related field.

Select which term of service you are interested in serving in:

Summer Term | May 13, 2024 - August 16, 2024

Earliest Date Available:

Application Process:

Applicants are encouraged to apply early as applications are considered on a rolling basis until all positions are filled. Qualified applicants are screened and interviewed by both CitySquare AmeriCorps and a partner agency before any formal offer can be made. Complete all portions of the application; incomplete applications will not be considered. If your application is being considered, you will be contacted within 7 days of submission.

Questions about this application? Email americorps@citysquare.org

Page 3

IV. Legal Information

Have you been convicted for any criminal offense other than minor traffic violations?

YesNo

Please list offenses and dates:

* Your certifying signature at the end of this application allows us to run a FBI background check on you prior to service. Failure to disclose all criminal history will result in disqualification from the program. If you are a registered sex offender or if you have been convicted or murder, you are not eligible to serve with AmeriCorps. Additionally, all positions may be subject to a pre-employment drug screening.

V. Work Experience/ Extracurricular Activities

Please list your previous work experience beginning with your most recent position. If you have no work experience, please list extracurricular activities, volunteer work, club membership, youth groups, or other leadership roles you have taken on in school or other organizations.

Company/Organization:

Position Title:

Date Started:

Date Ended:

Duties:

Company/Organization:

Position Title:

Date Started:

Date Ended:

Duties:

VI. Essay

Please complete the following essay question. Essays are evaluated on content, structure and grammar. Your response should be approximately 250-350 words. Applications with insufficient essays will not be considered complete and will not be reviewed.

How have you seen service to others make an impact in your community, or a community you are familiar with? (250-350 words)

CitySquare AmeriCorps is available to all, without regard to religion, race, color, national origin, gender, political affiliation, disability, sexual orientation, creed, or veteran status.

Page 4

VII. References

Please list 2 professional references below:

Examples of professional references: teachers, professors, past employers, etc.

Reference #1

Name:

Relationship:

Email:

Phone:

Reference #2

Name:

Relationship:

Email:

Phone:

VIII. Certification

The AmeriCorps application process requires a three-part National Service Criminal History Check. This background check requires a search of the (1) National Sex Offenders Website, (2) a Texas Department of Public Safety check and if applicable, a state repository check through your current state of residence* and (3) a FBI fingerprint background check.

I understand that to successfully complete the fingerprint background check and to eligible to serve I must provide a valid, unexpired photo ID, social security card, and documents confirming my citizenship status. I am aware that my identity must be verified with a government-issued photo ID. I understand that the results of these checks will be kept confidential. I understand that the results of these checks could affect my eligibility to serve with CitySquare AmeriCorps. I understand that I have the right to review the findings.

By typing my name in the space below and submitting electronically, I consent to the CitySquare AmeriCorps program to complete the above-mentioned criminal background checks. I certify that all the statements made in this application, including verification of high school diploma or equivalency 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. I understand that any offer to serve is contingent upon the result of the required three-part check and proof of my citizenship and age.

State of Residence:

*State of Residence is defined as the location you resided at the moment in time you completed this application.

Signatures

Applicant Signature

Please list any aliases or names previously used, such as maiden names

Applicant Signature (If applicant is under 18 years of age a parent must also sign below)

Date Signed

Parent Signature

For a parent or guardian of applicant under 18 years of age - By typing my name in the space below, and electronically, or by providing an original signature, I certify I have reviewed this application, and I authorize my son/daughter/legal ward to apply and, if selected, to participate in AmeriCorps.

Parent Signature (required only if applicant is under age 18)

Date Signed