Your Experience Counts Application
Complete each section. Those marked with an asterisk (*) are required. The form will not submit unless these fields are completed.
First Name
Your answer
Last Name
Your answer
Middle Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Street Address (If using a PO Box, please also include a street address)
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Email address
Your answer
Secondary Address (please indicate what months of the year)
Your answer
Primary Phone
Your answer
Secondary Phone
Your answer
Please provide the NAME & HOME/WORK PHONE NUMBERS of an emergency contact:
Your answer
Gender
Ethnicity
Highest level of education completed:
Skills & Experience: Please indicate skills you have acquired through training or experience, including volunteer roles.
PLEASE DO NOT LEAVE ANY ITEMS BLANK--THE FORM WILL NOT SUBMIT.
Not Skilled
Somewhat Skilled
Highly Skilled
Business/Entrepreneur
Chemical Science
Communications/Marketing
Computers/Technology
Fine Arts/Crafts
Foreign Language (specify below)
Fundraising/Grant Writing
Health/Wellness
Human Resources/Recruitment
Law
Leadership
Medicine
Public Speaking
Research/Statistics
Social Work (or other Helping Profession)
Teaching/Tutoring
Writing/Editing
If you marked "Highly Skilled" in any areas above, please explain how you gained those skills.
Your answer
Employment
List your current or most recent employer(s). Include self-employment, internships/fellowships, home management, and full- or part-time (paid/unpaid) work experience.
Your answer
Community Service
Identify a volunteer experience that worked well for you. What made this experience great? What are you hoping to gain through this volunteer experience?
Your answer
References
Please exclude immediate family members. SUBMIT 3 TOTAL REFERENCES: Name & Phone # for 1-professional reference & 1-personal reference. Include 1 other, either personal or professional. (If you prefer, this information may be submitted during the interview.)
Your answer
Are you a U.S. citizen, national, or lawful permanent resident alien?
Required
If you are a lawful permanent resident alien and you received your card after Jan. 1987, what is your registration number and card expiration date?
Your answer
Have you ever been convicted, or adjudicated as a juvenile offender, of any criminal offense by either a civilian or military court, other than a minor traffic violation?
Required
Are you currently under charges for any offense?
Required
Are you currently on probation or parole?
Required
How did you hear about us?
Required
Are you aware that we match YEC members with teachers to support 3-6th graders in core academic subjects, during the school day?
Are you able to commit at least 2 hours IN THE CLASSROOM per week, for the duration of the school year?
(Plus driving time)
Required
What is your limit on driving distance for volunteering?
please state drive time in MINUTES
Your answer
Here are our current district partners & general locations. Which of these locations would be reasonable driving distance for you?
CERTIFICATION: I certify that all of the statements made in this application are true, correct, and complete, to the best of my knowledge, and are made in good faith. I understand that misinformation or omission of information could result in disqualification and/or termination as a Your Experience Counts member. I understand that my selection for participation in the Your Experience Counts program may require a physical examination by my physician. I also give my consent for the background security check which is conducted annually for this program.
Please initial & date: "I have read and agree to this statement."
Your answer
Thank you for applying to become a YEC member! Below are the next steps in our intake process.
PLEASE CHECK OFF ALL ITEMS BELOW that you have NOT YET COMPLETED (this will most likely be all of them, unless you submitted paperwork at our office or an event table.)
Required
DO NOT CLOSE THIS WINDOW UNLESS YOU RECEIVE A "THANK YOU..." MESSAGE CONFIRMING THAT YOUR APPLICATION WENT THROUGH.
If the "Thank you..." message doesn't appear, scroll back through your application and fill in any questions that are marked in red.
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