Schools-Based AmeriCorps Program Member Application

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Schools-Based

AmeriCorps Program

Member Application

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Hands On Atlanta Schools-Based AmeriCorps Member Application 2013-2014 Page 2

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HANK YOU FOR APPLYING TO THE

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We are glad that you are interested in joining this exciting leadership program. Use the checklist below to guide you through the application process.

APPLICATION CHECKLIST

Please complete and submit the entire application and additional required materials to Hands On Atlanta. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED.

❏ Fully complete each section of the Hands On Atlanta Schools-Based AmeriCorps application. Provide truthful, accurate and complete information in response to each section of the application. No one at Hands On Atlanta has the authority to direct or authorize you to omit or falsify any information

requested by the application. The falsification of any information requested will result in the rejection of your application or, if discovered after your acceptance into the AmeriCorps Program, your dismissal from the program.

❏ Print or type your name at the top of each page. ❏ Provide the contact information for 2 references.

❏ Include a two-page type-written response to the essay questions detailed on page 8 of this application. ❏ Provide your signature in the validation section of the application.

❏ If selected, you will be required to undergo a State and Federal criminal background check at your expense (approximately $38). Upon successful completion of the program you will be reimbursed. ❏ If selected, you will also need to provide certain documents on the first day of Pre-Service Orientation,

August 19, 2013. The following documents must be the original with the appropriate seals:

O Documentation of citizenship or permanent resident status (US birth certificate, US Passport, 240, FS-545, DS 1350, n_550, N-570, N-560, N-561, Green Card/Form I-551 or I-94)

O Social Security Card

O _{State issued Photo Identification}

O _{Copy of High School Diploma/GED Certificate} ❏ Mail or fax your completed application to:

Attn: Schools-Based AmeriCorps Recruitment Hands On Atlanta

600 Means Street, Suite 100 Atlanta, GA 30318

Fax: (678) 916-4042

Understand that this is a service opportunity and not a regular employment position. The minimum service requirements are full-time, Mon.-Fri. 8:30 a.m.-6:00 p.m. with some weekends and evenings.

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Only 8% of kids growing up in low-income communities graduate from college by age 24 (Source: postsecondary.org). Hands On Atlanta Schools-Based AmeriCorps is your chance to be part of the solution. In the AmeriCorps program you’ll have the chance to become the next generation of leaders in education. As an AmeriCorps member, you’ll serve your community full-time for 10 months. You will use your talents, energies, and idealism to support a dynamic program that will address the most critical needs of Atlanta’s schools. The Hands On Atlanta Schools-Based AmeriCorps Program is looking for civic-minded individuals who exhibit leadership potential and have a passion for working with youth. We have found those that are most successful within AmeriCorps possess a belief that all children can learn, have superior interpersonal skills and a respect for individuals with diverse experiences. This is your chance to change the world around you.

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Hands On Atlanta helps individuals, families, corporate and community groups strengthen Greater Atlanta through service at more than 400 nonprofit organizations and schools. Hands On Atlanta volunteers are at work every day of the year tutoring and mentoring children, helping individuals and families make pathways out of poverty, improving Atlanta’s environment, and more. Hands On Atlanta is an affiliate of the HandsOn Network, an association of 250 volunteer service organizations across 16 countries. To learn more about Hands On Atlanta, visit our website at HandsOnAtlanta.org.

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AmeriCorps is a 10-month commitment that can change your life. More than 70,000 men and women like you are serving all over the country, turning their idealism into action through AmeriCorps. During your term of service, you will receive:

• A weekly living allowance, health and dental coverage, a childcare subsidy (if eligible), and federal student loan forbearance

• A chance to develop your leadership skills, teamwork and impact your community

• Upon completion of your term of service, you will receive a $5,550 educational award for college, vocational school, graduate school or to pay back student loans.

For more general information on AmeriCorps, visit

www.AmeriCorps.org

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To read first hand accounts from members about their service experience, visit

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ESCRIPTION

As a Hands On Atlanta Schools-Based AmeriCorps member, you will be given the opportunity to serve in elementary, middle, and high schools helping students improve their academic performance by closing the achievement gap. You and your fellow team members will support the public school system and individual students by engaging families, teachers, community members and corporations in the educational process. In general, AmeriCorps member responsibilities include: tutoring and mentoring, program documentation, upholding program standards, volunteer recruitment, assisting with training volunteers, service project development, special events planning, and participation in leadership development trainings.

Elementary and Middle School Placements

• Members serve as math and language arts tutors

• Small group tutor sessions designed to provide students with individualized attention to strengthen the foundational math and reading skills that many students lack

• Aid teachers and enrich learning through grade-level classroom assistance. • Associates degree or 60 credit hours post secondary education required • Bachelor’s degree preferred

High School Placements (Duties dependant on Service Site)

• Members serve in conjunction with Project GRAD to mentor students and increase their college readiness

• Ensure students meet requirements to earn Brumley-GRAD Scholarship through Project GRAD • Tutor students in math and support parental engagement efforts (non-Project GRAD schools) • Bachelor’s degree required

Volunteer Management Placements

• Serve with Project GRAD or Oglethorpe University • Organize service events and recruit volunteers • Bachelor’s degree required

Hands On Atlanta Schools-Based AmeriCorps members are challenged to fully participate in a cohesive, diverse, task-oriented team focused on school-based programming, service project implementation and general

leadership development. Members will be committed to community service, supporting the public school system and the individual student by engaging families, teachers, community members and corporations in education. Some ways in which you will do this include:

Schools-Based Program Development

AmeriCorps members will assist in the development of all aspects of daily service at their school. These

responsibilities include establishing a daily routine, developing and implementing creative and exciting activities for after-school and Saturday programs, and providing individual tutoring and mentoring for students.

Program Training

AmeriCorps members will participate fully in leadership development, service-learning integration, project development, diversity and literacy training. Members will spend the first two weeks of their service year in pre-service orientation at Hands On Atlanta. During pre-pre-service orientation, members will receive skills training essential to understanding: child development, school environments, parent engagement, diversity, curricula and intervention models, key stakeholder collaboration, Common Core standards, and tutoring/instructional techniques.

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Volunteer Management

AmeriCorps members will assist in the recruitment, retention and recognition of community volunteers who serve at various Hands On Atlanta and placement site projects, including the Discovery Program. In the Discovery Program, volunteers provide Saturday tutoring and enrichment programs to elementary schools throughout Greater Atlanta. Members will help plan bi-monthly Discovery sessions, recruit volunteers to deliver programming, and support volunteers in completion of assigned tasks during their service time. In addition, members will assist in maintaining a welcoming atmosphere and positive relationship between volunteers, school staff, students and Hands On Atlanta.

Special Events and Projects

AmeriCorps members will plan school-based special events and service projects such as: parents, friends and family night, AmeriCorps graduation, corporate sponsor days, Hands On Atlanta Day, etc. Members will assist with logistics, Hands On Atlanta site information, resources and soliciting in-kind donations. Members will also assist in engaging special visitors to the program and participate in visits to other AmeriCorps programs. Members will be expected to assume other organizational duties, roles and responsibilities as assigned when circumstances warrant. Each member will also develop and implement at least one individual service project during his/her term of service.

Benefits:

· A monthly living allowance of $1,210 · Basic health and dental insurance · Childcare subsidy, if eligible

· Loan forbearance for federal student loans

· Segal Education Award of $5,550 upon successful completion of service requirements TO APPLY, PLEASE SUBMIT:

• A fully completed application form • A Resume

• Original type-written essays, composed by you, that address the questions found on page 8 of the application (Combined 2 page limit).

INTERVIEW AND SELECTION TIMELINE:

May 21, 2013 1st round of Interviews begin June 17, 2013 2nd round of interviews begin June 24, 2013 Final round of interviews begin

July 15, 2013 Conditional offers extended pending background check results August 19, 2013 Pre-service orientation begins

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NFORMATION

Full Name__________________________________________________________________________________ Last First Middle Jr., III, Etc.

Name (preferred) __________________________________________Date of Birth ______ /______ /________ Month Day Year

Social Security #______________________ - __________________ - ______________________

Email Address _____________________________________________________________________________ Current Address___________________________________________________________________________ _________________________________________________________________________________________

City State Zip

Telephone 1 (____) ___________________________Telephone 2 (____) ______________________________ PermanentAddress_________________________________________________________________________

(If different from address above)

_________________________________________________________________________________________ 1st Emergency Contact ______________________ 2nd Emergency Contact ________________________ Relationship to You _________________________ Relationship to You __________________________ Address __________________________________ Address ___________________________________ _______________________________________ ___________________________________________

City State Zip City State Zip

Telephone (____) ___________________________ Telephone (____) _________________________

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DUCATION

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Please check the highest level of education that you have completed, and completely fill in educational information. ❏ High School Diploma ❏ GED ❏ A.S. ❏ B.A., B.S. ❏ Graduate (Masters, J.D., Ph.D.) ❏ Technical/Trade Do not declare a degree that you have not earned.

School Complete School Name City and State From (Yr/Mo) To (Yr/Mo) Degree Earned High School College Technical/Trade Graduate

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XPERIENCE

List and briefly describe the most recent employment/work positions you have held. Include self-employment, internships/fellowships, home management and full or part-time experience.

Employer Name: ______________________________________ Location: _____________________________ Phone: _____________________Dates of involvement: ________ to ________ Hours per month: __________ Title/Description of Duties: ___________________________________________________________________ __________________________________________________________________________________________

Employer Name: _______________________________________Location: _____________________________ Phone: _____________________Dates of involvement: ________ to ________ Hours per month: __________ Title/Description of Duties: ___________________________________________________________________ __________________________________________________________________________________________

Employer Name: ______________________________________ Location: _____________________________ Phone: _____________________Dates of involvement: ________ to ________ Hours per month: __________ Title/Description of Duties: ___________________________________________________________________ __________________________________________________________________________________________

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UESTIONS

1. Please answer all three (3) of the essay questions listed below in two (2) total pages or less. These must be original, type-written essays, composed by you, that address the following questions/situations:

1. We would like to understand more about you and your reasons for applying to AmeriCorps. Take a few minutes and consider those experiences that have made you the person you are today. Please share with us one of these experiences and how it sparked your interest in community service. 2. Hands On Atlanta seeks to identify civic-minded leaders who will become agents of positive

transformation in the schools and in their communities. Describe something that you appreciate and something you would like to change about your current community. Also describe what leadership skills you will need to improve during your corps year to serve your community and bring about the transformation you hope for.

3. Given that we often work in under-resourced communities how do you feel we can level the playing field, close the achievement gap and give children the same quality of education as children in more affluent areas?

2. If selected, in what role do you feel most qualified to serve? (Check one) ❏ Elementary school

❏ Middle school ❏ High school

❏ Volunteer Management Why?

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OLUNTARY

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ISCLOSURE

Hands On Atlanta Schools-Based AmeriCorps actively seeks to include participants of diverse backgrounds. Diverse backgrounds include but are not limited to race, ethnicity, religious beliefs, socio-economic and education level, gender, sexual orientation and disability. Disclosure is not required to be considered for participation.

• Gender ❏ Male ❏ Female ❏ Prefer not to say • What languages do you speak fluently?

_______________________________________________________________________________________ • Racial or ethnic group; please check one or more if applicable.

❏ American Indian/Alaska Native ❏ Black/African American ❏ White

❏ Hispanic/Latino

❏ Native Hawaiian or Other Pacific Islander ❏ Asian ❏Other _____________________________________ Additional Comments: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

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ISCLOSURE

1. Have you previously participated in an AmeriCorps/National Service program? No___Yes___ If Yes, how many times_____. If your answer is no, please skip to the next section of this application, (do not answer the next 5 questions).

2. Did you successfully complete term of service? No____Yes___

a. If you answered no, are you currently enrolled in an AmeriCorps program? ___Yes___No b. What is your expected date of completion?___________________

c. If you answered yes, please explain: _______________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

i. What dates did you serve from? _______to________

ii. What was your program name and location? ________________________________ iii. What was your Program Director and/or direct Supervisor Name?

______________________________________________________________________ iv. What is the phone # for the supervisor/organization___________________________

v. What is the email for the supervisor/organization_____________________________

3. Did you receive a full or partial education award for service completion? a. Full education award received Yes____No___

b. Partial education award received Yes____No____

4. Have you ever been released ‘for cause’ from a term of service by this or any other AmeriCorps program? No____Yes_____

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HANDS ON ATLANTA

DISCLOSURE REGARDING CONSUMER REPORTS AND INVESTIGATIVE CONSUMER REPORTS

Consumer reports or investigative consumer reports about you may be obtained by Hands On Atlanta, Inc. (“HOA”) for employment purposes. A consumer report is a report issued by a consumer reporting agency containing information bearing on your credit-worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and/or mode of living. An investigative consumer report is a special type of consumer report containing information about your character, general reputation, personal characteristics, and/or mode of living that is obtained through personal interviews with your neighbors, friends, associates, former employers, and others with whom you are acquainted. The report that HOA expects to request may contain, among other things, information about any criminal record you may have, information about your past employment, information about your licenses and academic record, information from your personal and/or employment references, information about your credit record, and information about your past residential addresses. If you wish, you may submit a written request to HOA to learn the nature and scope of the investigation requested in connection with any investigative consumer report that HOA requests. Upon receipt of your written request, HOA will inform you in writing of whether it has requested an investigative consumer report and, if it has, of the nature and scope of the investigation it requested. For further information, please consult the summary of your rights under federal law with respect to consumer reports, which accompanies this Disclosure and Authorization Form.

AUTHORIZATION TO OBTAIN CONSUMER REPORTS AND INVESTIGATIVE CONSUMER REPORTS

I hereby authorize Hands On Atlanta, Inc. (“HOA”), at any time prior to or during my employment with HOA, to procure or have prepared consumer reports and/or investigative consumer reports about me for employment purposes. I understand that HOA or its successors may, from time to time, request consumer reports and/or investigative consumer reports for the purpose of evaluating me for promotion, reassignment, or retention as an employee, and I hereby authorize the procurement of such consumer reports and investigative consumer reports.

______________________________ ________________________________________

(Printed Full Name) (Signature)

______________________________ Date

Present Address: ______________________________________________

City: _______________________________ State: _______ Zip Code: ________ Area Code / Phone Number: ___________________ (h) ____________________ (w)

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DIRECTION TO CONSUMER REPORTING AGENCY TO PREPARE CONSUMER REPORT

I, ____________________________, direct LexisNexis to prepare such consumer reports or investigative consumer reports about me as may be requested by Hands On Atlanta, Inc. and to disclose those reports to Hands on Atlanta, Inc. The scope of those reports shall be determined by Hands On Atlanta, Inc., which shall be solely responsible for the cost of preparing those reports. The reports that I hereby direct LexisNexis to prepare and disclose to Hands On Atlanta, Inc. will be requested in connection with my volunteer services on behalf of Hands On Atlanta, Inc. or my request to perform such services.

Signature: Printed Name: Date:

Social Security Number: Date of Birth:

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Please note that convictions shall include: a finding of guilty by a judge or jury, a plea of guilty, or a plea of nolo contendere. If you answer yes to any of the questions below, please explain fully on a separate sheet of paper. Include the date, place and nature of each such conviction or pending charge and the final disposition of the case. You must disclose all convictions no matter how minor the offense unless you have been expressly authorized by the court that entered the conviction not to disclose it in response to an inquiry about criminal convictions. If you do not disclose the conviction on this application and a criminal background check reveals the conviction you will be required to produce the document from the court expressly authorizing you not to disclose the conviction. If you fail to do so you will be deemed to have improperly omitted the conviction from this application

Traffic violations are considered a criminal offense in the state of Georgia.

Disclosing information or having a finding on your record does not necessarily exclude you from participating. However, an individual who refuses to consent to a criminal registry check, has been convicted of murder, is a registered sex offender, OR who makes a false statement in connection with a grantee’s inquiry concerning the individual’s criminal history, is not eligible to serve in the program as per federal regulations. Additionally Hands on Atlanta may deem you ineligible to participate due to other offenses. For a complete list of offenses that may disqualify you form serving in our program please go to:

http://www.handsonatlanta.org/servlet/servlet.FileDownload?file=015A0000002hfSA

Prior to admission to the program all members will undergo a State and FBI background check and a National Sexual Offender Public Registry check.

DOCUMENTATION WILL BE REQUIRED

1. Are you legally authorized to work in the United States? ❏ Yes ❏ No

2. Residency status: In what state are you a permanent resident? ______________________ 3. Have you ever been convicted of a crime or are any criminal charges now pending against you?

❏Yes ❏ No

4. Are you currently on parole or probation for any offense?

❏ Yes ❏ No

If you answered yes to questions 3 or 4 please attach an explanation with details and dates of offenses.

AUTHORIZATION: I, ________________________________ (applicants name), hereby authorize Hands On Atlanta

and/or their authorized agents to gather any and all information regarding my criminal record, driving record, and my education record; and any other pertinent information relating to the function of the position for which I am applying. This authorization includes allowing Hands On Atlanta to obtain the results of an FBI criminal history check, National Sex Offender Public Registry check, and a statewide criminal history check. I also authorize Hands On Atlanta and/or any of their authorized agents to gather this information at any time during my service.

_____________________________________________________________ _______________________

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ECOMMENDATIONS

Hands On Atlanta School-Based AmeriCorps requires that you provide the names of two previous supervisors who can act as references to your qualifications for our program. References can not be relatives of the applicant. Reference 1 Name: Title: Relationship: E-Mail: Phone: Reference 2 Name: Title: Relationship: E-Mail: Phone:

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ALIDATION

I hereby state that the information given by me in this application is complete and true in all respects. The opinions expressed are my own. I understand that misrepresentation or omission of facts may result in cancellation of any consideration for participation in the Hands On Atlanta AmeriCorps program, or if I am selected as an AmeriCorps member, dismissal. I understand that Hands On Atlanta maintains a Drug-Free Workplace. I further understand that Hands On Atlanta has implemented a Drug-Free Workplace policy and that adherence and consent to this policy is a condition of enrollment in the AmeriCorps Program. If I am offered a position in the Hands On Atlanta AmeriCorps program, I understand that either I or Hands On Atlanta will have the right to terminate this relationship at any time, with or with out cause and that I will not be an employee of Hands On Atlanta.