AmeriCorps Program Application
Please print this page and complete all sections of this application. Please also provide a signature where requested.
Thank you for your interest in the CARITAS AmeriCorps program. This is an AmeriCorps funded position. AmeriCorps service is stipended volunteerism. We are looking for individuals whose primary motivation for seeking the position is a desire to help the community and is not solely financial in nature. AmeriCorps members receive a living allowance (or stipend) which is paid evenly over the service term and an education grant at the conclusion of your term of service. All terms of service conclude on August 31.
Position Applied For: ___________________________________________
CARITAS is an Equal Opportunity Employer and does not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status as defined in local, state, or federal law.
Personal Information
Name ___________________________________ _____________________________________ _______
Last First Initial
Address ______________________________________________________________________________
Street City State Zip
Telephone ( ) _______ – ___________ Social Security Number _______ – ____ – ________
Email address: _________________________________________________________________________
Circle Your Responses
| Are you 18 years of age or older? Yes No | |
| Have you applied for a job with CARITAS in the past? Yes No | Do you have a Driver’s License? Yes No |
| Have you ever been terminated from employment? Yes No
If so, please state the circumstances:
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May we contact your current employer for information? Yes No |
| Type of employment sought: Full Time Part Time Temporary |
When are you available to begin? _____________________ |
| Will you provide proof of your legal work status when requested? Yes No
Do you have any friends or relatives employed by CARITAS? Yes No If so, who? Have you ever worked for CARITAS before? Yes No If so, when? If you were offered a full time position elsewhere, would you accept it? Yes No
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At CARITAS, we view past barriers as stepping stones rather than barriers. Have you ever been convicted of a crime? Yes No (not traffic violations)
If yes, please state the circumstances *:
*NOTE: No applicant will be denied employment solely on the grounds of a conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered. |
| What days and hours can you work? Anytime Sunday Monday Tuesday Wednesday Thursday Friday Saturday | |
Full disclosure of criminal activity: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I, _____________________, give CARITAS permission to obtain a Criminal History Record/Sex Offender & Crimes Against Minors Registry Search (VA State Police form SP 230), State (sp – 167) and an FBI fingerprint background check as a condition of my employment with CARITAS. I understand that this information will be maintained in my personnel file and will remain confidential.
Last Name ______________________ Date of Birth ___________
First Name ______________________ Soc. Security Number
Middle Name _____________________ ______________________
Maiden Name ____________________ Sex: M F
Race: Asian/Pacific Black White Indian/Alaskan Other
Signature:__________________________________________________________
Date:___________________
Educational Background
(Begin with most recent)
| Name and Address of School
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Number |
Degree, Diploma, or Certificate Attained |
Major Field |
Graduated? |
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Employment History
(Include all prior employment (even if you plan to attach your resume) and begin with most recent.)
Employer: ________________________________________________ Phone ( ) _____ – ____________
Address _________________________________________________________________________________
Supervisor: __________________________ Your Position/Duties: ____________________
_______________________________________________________________________________________
Type of Employment (FT/PT/Temp):
Reason for leaving: ________________________________________________________________________
Date Hired: _____________ Starting Rate of Pay: _____________
Date Terminated: ___________ Last Rate of Pay: ________________
Employer: ________________________________________________ Phone ( ) _____ – ____________
Address _________________________________________________________________________________
Supervisor: __________________________ Your Position/Duties: ____________________
______________________________________________________________________________________
Type of Employment (FT/PT/Temp):
Reason for leaving: ________________________________________________________________________
Date Hired: _____________ Starting Rate of Pay: _____________
Date Terminated: ___________ Last Rate of Pay: ________________
References
Name:
Company:
Address:
Telephone Number:
Number of Years Acquainted:
Name:
Company:
Address:
Telephone Number:
Number of Years Acquainted:
Name:
Company:
Address:
Telephone Number:
Number of Years Acquainted:
If referred by a current CARITAS employee, please provide the name of the employee: _ ______
Applicant’s Certification
I certify and affirm that the information provided by me during interviews, on this application and all other related documents to be true in all respects, and I further understand that any false or misleading statements or omissions, whenever discovered, will be grounds for immediate termination from further consideration or termination of employment.
I understand and agree that nothing in this Application or anything conveyed during any interviews is intended to create a contract for employment with CARITAS. If employed by CARITAS, I agree to conform to the guidelines and policies of CARITAS.
I understand that I or CARITAS may terminate my employment at any time, with or without cause, and that any assurances of continued employment, whether written, oral or by conduct, shall not be interpreted as changing the “at will” nature of my employment relationship with CARITAS, unless specifically acknowledged in writing by an authorized officer of CARITAS.
I understand that if I am offered employment, I will be required to satisfy the requirements of the Immigration and Control Act by showing eligibility for legal employment in the U.S. within three (3) business days of the date employment begins.
I understand that CARITAS may conduct a routine background investigation in connection with my application for employment including but not limited to a criminal background check.
I authorize CARITAS to verify all references and information provided by my in this application. I release CARITAS, and any person or company responding to any reference or request for information from any claim or liability regarding any information or opinion supplied.
I understand that this application is good for only sixty (60) days from today’s date.
_________________________ ___________________________
Applicant’s Signature Date