An Equal Opportunity Employer
Application for Employment and AmeriCorps Positions

     Thank you for your interest in EducationWorks. Please note AmeriCorps applicants must complete Parts A, B and C. Applicants for staff postions must complete Parts A and C.

     Incomplete applications will not be reviewed.

Part A: TO BE COMPLETED BY ALL APPLICANTS
fields marked with an "*" are required

PERSONAL INFORMATION
Last Name*:
 First Name*:
 Middle Initial:
 Social Security Number:
- -
Present Address*:
 Apartment Number:
City*:
 State*:
 Zip*:
- 		Phone*:
Position(s) Desired:
AmeriCorps         EW Staff 		Dates if you applied to EducationWorks or National School and Community Corps previously:
Title*:
Dates if you have worked for EducationWorks or National School and Community Corps previously:
From:    To:       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.
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
EducationWorks will check all staff and 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 or continued employment. If you have been arrested or investigated for child abuse or investigated for a crime of any kind and you do not reveal it below, you may be disqualified or dismissed from EducationWorks, regardless of the circumstances. (Even if you were told that your record would be expunged or closed, you must answer "yes" below and explain what it was.)

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:

PART B: TO BE COMPLETED BY AMERICORPS APPLICANTS
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. If English is not your first language, you may write your essay in your native language.

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)


PART C: To Be Completed by ALL Applicants

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 HIRED, AN ANNUAL CHECK OF CRIMINAL AND CHILD ABUSE RECORDS.

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:*