Summer Corps Member Application

Please select the Jumpstart program to which you would like to apply: *

Please review the position descriptions for the available positions

Which position are you applying for?

New Corps Member

Returning Corps Member (you already served a complete program year with Jumpstart)

New Team Leader

Returning Team Leader (you were a team leader before)

Biographical Information

(Use your legal name that matches your identification documents)

Legal First Name: *

Legal Middle Name: *

I do not have a middle name

Legal Last Name: *

Preferred Name/Nickname:

To enroll as a Jumpstart Corps member, proof of your identity will be required upon acceptance. To enroll as a Jumpstart AmeriCorps member, you must be a U.S. citizen, U.S. national, or legal, permanent resident and be able to provide proof of such status.

Please check one*

I am a citizen or permanent resident of the United States.

I am not a citizen or permanent resident of the United States.

Social Security #: *

OR I don't have a Social Security Number

(This is a secure system and this number will only be used for Criminal History Checks)

Will you be 18 or older on May 15, 2018? *

Yes

Date of Birth: (MM/DD/YYYY)

/ /

College/University: *

OR N/A

Expected Graduation Date: *

Major Focus of Study: *

OR N/A

Student ID#: *

I do not know my Student ID#

Federal Work-Study

Eligible for Federal Work-Study Award: *

Yes

Don't Know

Federal Work-Study Award Amount: *

I don't know

N/A

If you are not eligible for federal work-study, would you be willing to participate in Jumpstart as a volunteer?

Yes

Unsure

Mailing Address of Residence during Service Term

Address: *

Address - Line 2:

City: *

State:*

Zip: *

Phone #: *

Home

Cell

Active Email Address: *

Permanent Mailing Address

Address at which you can always be reached, e.g. parent/guardians' address

Address: *

Address - Line 2:

City: *

State: *

Zip: *

Permanent Phone #: *

Home

Cell

Email: * (Should not be a school email but a Gmail, Yahoo, etc. that can be used beyond your service term)

Emergency Contact Information

Contact Name:*

Relationship to You:*

Emergency Contact's Primary Phone#*

In accordance with federal, state and local regulations governing our work with children, all applicants must consent to a criminal history check, and selection into the program is contingent upon Jumpstart's review of the applicant's criminal history, if any. Criminal history checks may be conducted through federal, state and/or third-party consumer reporting agencies, and may include a fingerprint check or other screening service as mandated by federal, state and local regulations. Please note that anyone who is required to register on a state sex offender registry or who is convicted of murder is automatically ineligible to serve.

Would you be willing to complete Jumpstart's criminal history check as described above? *

Yes

Applicants may need to provide health documentation (such as TB tests, vaccinations, and other results) as required by state or local regulation in order to serve in preschool settings

Would you be willing to provide health documentation if required? *

Yes

Have you served any previous terms with AmeriCorps? This would include past terms (whether completed or not) with NCCC, VISTA, Jumpstart or other AmeriCorps or national service programs.*

Yes

If yes, please list the program(s) with which you served, the year you served, and the location (city and state) of that service. Please also note whether you successfully completed your terms of service and whether you received a Segal AmeriCorps Education Award

Availability

Please list the days and times that you are available to work with Jumpstart. Only list your availability between the hours of 8 a.m. and 6 p.m.

Monday

Tuesday

Wednesday

Thursday

Friday

I do NOT yet know my availability.

Optional - Upload a copy of your resume (max file size MB)

Certification

By signing below, I attest that all statements made in this application are accurate and truthful and understand that any misrepresentations or false statements made in this application may result in not being considered for service, and that if not discovered by Jumpstart until after acceptance, such misrepresentations could be grounds for immediate termination. *

Initials:

Date application submitted:(MM/DD/YYYY) / /

Jumpstart is an equal opportunity organization and encourages applications from all individuals without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, amnesty, political affiliation, or status as a covered veteran in accordance with all applicable federal, state and local laws. Qualified individuals with disabilities are strongly encouraged to apply. Jumpstart will make reasonable accommodations for qualified individuals throughout the application process and during Jumpstart service. Accommodation requests should be directed to the Jumpstart office to which you are applying. Jumpstart is a proud member of the AmeriCorps national service network. Please note that not all Jumpstart sites are directly supported by AmeriCorps. Please contact the site to which you are applying for more information.

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