2017-2018 AmeriCorpsAbility Philadelphia Member Application
- Name of Organization Being Served: The Arc of Philadelphia
- Dates of Service: Sept. 2017-July 2018
- Member Type: Full Time | Achieving 1700 Hours
- Service Time: 8am-4pm weekdays. Average 38 hours per week, including National Service Days and the possibility of some weekends with notice.
- Member Service Objective: Member serves as a mentor for individuals with intellectual & developmental disabilities (I/DD) in Philadelphia county toward inclusion in their community. The members are serving in partnership with The Arc of Philadelphia and agree to abide by the mission & vision of the agency. Member will have recurring access to vulnerable populations including young, elderly and individuals with disabilities.

For position details and benefits please visit our website: http://arcphiladelphia.org/arc_philadelphia/americorps/become-a-member.html

Full Name (First/ Middle/ Last) *
Your answer
AmeriCorps Members must be a United States citizen, U.S. national or lawful permanent resident. Are you a United States citizen, U.S. national or lawful permanent resident? *
Final four (4) numbers of social security number *
Your answer
Date of Birth (Month/ Day/ Year) *
Your answer
Place of Birth (City/ State/ Country) *
Your answer
Gender *
Current Address (Number & Street/ City/ State/ Zip) *
Your answer
Phone Number (indicate home or cell) *
Your answer
Email Address *
Your answer
Emergency Contact (Name/ Relationship) *
Your answer
I give my permission for the AmeriCorpsAbility program to conduct a criminal history check. I further consent to the release of criminal history check information to the AmeriCorpsAbility program. I understand that an individual who refuses to consent to a criminal history check is ineligible to serve. *
Check the highest level of education that you have completed by the time you are planning to serve (Choose only one.) *
List all of the schools beginning with high school that you have attended, including trade or technical schools, military training, and employment programs. *
Name of School/ Location of School/ Dates Attended/ Major or Area of Study/ Type of Degree or Certificate Earned/ Date Received or Expected
Your answer
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- that is, what you learned and how it made you feel. List your most recent activity first. *
Your answer
Please describe your level of experience working with our target population-- individuals with intellectual and developmental disabilities. *
Your answer
Listed below are various skills areas. Indicate those which you have had experience or training, including volunteer or community service experience. (Choose all that apply.) *
Required
Please describe your level of computer literacy and experience (web-based systems, Microsoft Office, programming, etc.). *
Your answer
Do you have a valid driver’s license? Include license number and State *
Your answer
Agreement:
By signing this Electronic Signature Acknowledgement, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my signature is not legally binding.

Electronic Signature: By typing my name below, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my signature is not legally binding.

Please type your First and Last Name below: *
Your answer
I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this AmeriCorpsAbility service member application. *
Required
Today's date: *
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