AmeriCorps Instructor Application

  • AmeriCorps Instructor Application

    Travis County 4-H CAPITAL AmeriCorps Project

  • Welcome to 4-H CAPITAL! Please note that this form will not allow you to save your application before you submit, so plan to complete all pages at one time.

    Please fill out the form below or contact us at 4-HRecruitment@traviscountytx.gov

  • BASIC INFORMATION

  • Date of Birth*
     / /
  • Format: (000) 000-0000.
  • Is Permanent Mailing Address different from Current Address above?
  • Do you currently have a valid driver's license, passport, or government-issued photo ID?
  • Are you a U.S. citizen, national, or legal permanent resident alien of the U.S.?

  • CRIMINAL BACKGROUND CHECK

    Because this position involves working with vulnerable populations, your eligibility to serve as an AmeriCorps member is contingent upon a multi-part criminal background check (paid for by the program) and includes the following:

    - Texas state criminal background check
    - Another states criminal background check (if applicable)
    - FBI fingerprint check
    - National Offender Registry Clearance
    - School district fingerprint check

  • Have you ever been convicted as an adult, or adjudicated as a juvenile offender, of at least one criminal offense by either a civilian or military court?
  • Are you currently facing charges for any offense, on probation or parole?
  • I understand that making a false statement in connection with the criminal history check, including a false response to the criminal history background question on the AmeriCorps application, makes me ineligible to serve.
  • One of the essential functions of this position is to travel to multiple worksites. This may include but is not limited to traveling and transporting materials from our office to school sites or tending to garden beds and live animals on various campuses. 4-H CAPITAL provides materials and equipment for afterschool science club activities. Mileage is reimbursed for travel from worksite to worksite for those driving personal vehicles. Can you perform this essential function with or without reasonable accommodations?
  • Earliest Availability Date
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  • MOTIVATIONAL STATEMENT

  • EMPLOYMENT HISTORY

  • Do you have any previous employment experience?

  • Beginning with the most current or most recent position, list and briefly describe up to the last four positions you have held, or your last ten years of employment you have had. Include self-employment, internships/fellowships, home management, and full- or part-time paid or unpaid work experience.

  • Format: (000) 000-0000.
  • Start Date
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  • End Date
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  • Additional Position to Add
  • Format: (000) 000-0000.
  • Start Date
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  • End Date
     / /
  • Additional Position to Add
  • Format: (000) 000-0000.
  • Start Date
     / /
  • End Date
     / /
  • Additional Position to Add
  • Format: (000) 000-0000.
  • Start Date
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  • End Date
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  • EDUCATION

  • Highest Level of Education - Check the highest level of education that you will have completed by the time you are planning to serve in AmeriCorps.

  • Post-secondary School
    Starting with the most recent, list all schools after high school that you have attended, including trade or technical schools, military training, and employment training programs.

  • Attended from
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  • Attended through
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  • Date received or expected
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  • Do you have another school to add?
  • Attended from
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  • Attended through
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  • Date received or expected
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  • Do you have another school to add?
  • Attended from
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  • Attended through
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  • Date received or expected
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  • COMMUNITY SERVICE/VOLUNTEER

  • Please list the organizations with which you've performed volunteer or community service. List your most recent activity first. Your involvement could include serving in neighborhood, school, religious, social, professional, or other volunteer groups; helping out with community service projects; or participating in less formal activities.

  • Do you have any community service experience?
  • Format: (000) 000-0000.
  • Date of involvement from
     / /
  • Date of involvement to
     / /
  • Do you have another community service/Volunteer position to add?
  • Format: (000) 000-0000.
  • Date of involvement from
     / /
  • Date of involvement to
     / /
  • Do you have another community service/Volunteer position to add?
  • Format: (000) 000-0000.
  • Date of involvement from
     / /
  • Date of involvement to
     / /

  • LOAN FORBEARANCE

  • As an AmeriCorps member you may be eligible for forbearance on your qualified student loans during your term of service. Forbearance is granted by the Financial Institution, not by CNCS, and depends on both the Financial Institution and type of loan that you have. If you plan to place your student loans on forbearance, it is important to check with your Financial Institution because some types of loans may not qualify. I understand that I can find more information about loan forbearance on my.americorps.gov, and that links to CNCS sponsored help pages were provided in the Program Description PDF.

  • DEMOGRAPHIC INFORMATION

  • CNCS gathers information about sex, race, ethnicity, and other demographic information to ensure opportunities are provided to serve for people of all conditions. This information will be held confidentially and will solely be used for data analysis to assist us in ensuring we serve all Americans equally. The information you provide will not be used in any way to determine or affect any federal benefit. Your responses about ethnic or racial origin are voluntary on this application but will be required to be enrolled as an AmeriCorps member. This information will be kept confidential.

  • Which of the following categories best describes your racial origin? Check all that apply.
  • How did you hear about this program?
  • Have you previously served with an AmeriCorps program?

  • REFERENCES

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • INTERVIEW TIMES

  • If you are chosen for an interview, please let us know the best time to schedule your interview. These can be in-person (if residing in Austin) and on Zoom (a link will be sent prior). Interviews typically last less than an hour -- the time ranges below are simply to learn your best availability
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