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2017-2018 Arkansas GardenCorps Online Service Member Application

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Please complete the following Arkansas GardenCorps Service Member application. Please contact Emily English at esenglish@uams.edu or 501.364.3390 if you have any questions.

For more information about Arkansas GardenCorps and the Service Member position, please download the 2017-2018 Service Member information document below.

Attachment:2017-2018 Service Member information.docx

Full First Name:

Full Middle Name:

Full Last Name:

Have you ever gone by any other legal name(s)?

Yes

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Previous First Name:

Previous Middle Name:

Previous Last Name:

AmeriCorps members must be a United States citizen, U.S. national or lawful permanent resident. Are you a United States citizen, national, or lawful permanent resident alien?

Yes

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If you are a lawful permanent resident alien and you received your card after January 1987, what is your registration number and card expiration date?

FINAL FOUR NUMBERS OF SOCIAL SECURITY NUMBER:

DATE OF BIRTH:

M-D-Y

PLACE OF BIRTH:

GENDER:

Male

Female

Other

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Earliest date you are available to begin service:

M-D-Y

NUMBER AND STREET:

CITY:

STATE:

ZIP CODE:

Phone:

E-Mail:

Have you been a resident in any other state in the last two years?

Yes

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If yes, what state(s)?

Are you planning to move anywhere else in the next 3 months?

Yes

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If yes, what state?

Please give the name and address of a person through whom you can always be reached:

First Name:

Last Name:

Relationship:

NUMBER AND STREET:

CITY:

STATE:

ZIP CODE:

Home Phone:

Work Phone:

Cell Phone:

E-Mail:

Do you have a service site preference or regional preference for where you would like to serve in Arkansas GardenCorps?

Yes

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If yes, please list a preferred region or service site in order of preference. Service sites will not be officially selected until June 2017.

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Are you interested in serving in a full-time or part-time capacity?

Full-time (1700 hours between September 5, 2017 and August 26, 2018)

Part-time (900 hours between September 5, 2017 and August 26, 2018)

Either

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Do you prefer to serve school gardens or community gardens?

School

Community

No Preference

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Do you prefer to serve in a rural or urban environment?

Rural

Urban

No Preference

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Have you served with AmeriCorps in the past?

Yes

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If yes, what was the name of the program and how many hours were you expected to complete?

Where was it located?

How many hours did you complete?

Choose the highest level of education that you will have completed by the time you are planning to serve
in AmeriCorps.

Some high school

High school diploma or GED

Technical school/Apprenticeship

Associate's degree

Some college

Bachelor's degree

Graduate degree

Other:

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Please specify:

List all schools after high school that you have attended, including trade or technical schools, military training and employment training programs.

Name of School:

Location of School:

Dates Attended

Major or Area of Study:

Type of Degree or Certificate:

Date Received or Expected:

Name of School:

Location of School:

Major or Area of Study:

Type of Degree or Certificate:

Date Received or Expected:

Name of School:

Location of School:

Dates Attended

Major or Area of Study:

Type of Degree or Certificate:

Date Received or Expected:

Name of School:

Dates Attended

Location of School:

Dates Attended

Major or Area of Study:

Type of Degree or Certificate:

Date Received or Expected:

Describe how you have reached out to help others and/or how you have been involved in your own community. Explain why you decided to serve or get involved, and what you received in return (what you learned or how it made you feel). Think in broad terms. (Your involvement could include serving in your neighborhood, school, religious, social, professional, or other volunteer groups; helping out with community service projects; or participating in less formal activities.)

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We would like to understand more about you and your reasons for applying to Arkansas GardenCorps. Take a few minutes and consider those experiences which have made you the person you are today. Please share
with us one of these experiences and how it sparked your interest in Arkansas GardenCorps.

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How do you envision your year of community service with Arkansas GardenCorps impacting your future career path?

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Please upload a resume here. This should include your employment and community service history and a brief description of each position along with dates served.

Upload file

Listed below are skill areas that our service sites find useful and may seek in Arkansas GardenCorps applicants. Indicate the skill areas in which you have had training or experience, including volunteer or community service experience, and indicate how you gained those skills.

Business/Entrepreneur

Communications

Community Organizing/Development

Computers/Technology

Conflict Resolution/Counseling

General Education

Garden-Based Education

Fine Arts/Crafts

First Aid

Fundraising/Grant Writing

Leadership

Public Health

Public Speaking

Recruitment

Teaching/Tutoring

Construction

Writing/Editing

Youth Development

Gardening

Organic Gardening Practices

Food Recovery

Farmers Market Booth Management

Do you know or have you studied any language(s) other than English?

Yes

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Language(s):

Number of years studied or spoken:

In the space below, provide any additional skills and experience that may be helpful in evaluating your application.

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Do you have a valid driver's license?

Yes

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License #:

State:

The AmeriCorps application process requires a criminal history check to ensure that community members with whom we work are protected, particularly children, individuals with disabilities, and individuals over 60
years old.

We will investigate for past sexual offenses and violent crimes, or crimes that would have a direct bearing on your service.

This background check will entail our search of the National Sex Offenders Registry and an FBI criminal
history check, which will require you to be fingerprinted during the enrollment process.

You will not be permitted to serve or work with children, individuals with disabilities, or individuals over 60 years of age, without supervision until the criminal history check is complete and you are cleared. The review process is not lengthy, and normally is completed within weeks.

Answer the following questions fully. Existence of a criminal conviction or juvenile adjudication may or may not, depending on the circumstances, disqualify you from consideration. However, any intentional misrepresentation or omission will disqualify you. Do not include minor traffic violations.

I allow the AmeriCorps program to complete an NSOPR check and criminal background check

Yes

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Have you ever been convicted as an adult, or adjudicated as a juvenile offender, of any criminal
offense by either a civilian or military court, other than minor traffic violations?

Yes

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Are you currently facing charges for any offense or on probation or parole?

Yes

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Date:

Yes

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Place:

Charge:

Action Taken:

Court, Probation, or Parole Officer:

Phone:

NUMBER AND STREET:

CITY:

STATE:

ZIP CODE:

Arkansas Children's Hospital, the Human Resources administrator of Arkansas GardenCorps, requires a drug screen, tobacco screen, TB skin test, and a flu shot (unless approved on time for religious or philosophical exemption). If selected to serve in Arkansas GardenCorps, do you agree to complete these requirements?

Yes

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Please provide contact information for two references. Select people who know you well and who are familiar with your personal background, education, employment, and/or professional skills. You should not ask a family member, peer, classmate, co-worker, or friend to serve as a reference. Consider asking work supervisors, clergy, teachers, counselors, coaches, or someone else familiar with your motivation, service ethic, and community involvement.

* must provide value

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