Our policy is to provide equal opportunity to all qualified persons without regard to race, creed, color, religious belief, sex (including pregnancy), sexual orientation, gender identity, age, national origin, ancestry, physical or mental disability, or veteran status.

This is a full-time AmeriCorps service position, through the Appalachian RC&D Council (ARCD). All AmeriCorps members must pass a criminal background check. Acceptance as an AmeriCorps member is contingent on organizational review of criminal history.

* Anyone who refuses to consent to checks will be ineligible to serve.

* Anyone listed or required to be listed on a sex offender registry is ineligible to serve.

* Anyone convicted of murder is ineligible to serve.

* All other offenses will be handled on a case by case basis depending upon the service site and job description.

Name and Address

Citizenship Information

Criminal Background Information


Employment History

Start with most recent employer.

Education History

Continued Education

Other Experience and Skills


List three personal or professional references, not related to you, who have known you for more than one year.

Emergency Contact


Please Read Before Signing:

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.

I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record.

I agree that this company and my previous employers will not be held liable in any respect if an AmeriCorps service position is not extended, or is withdrawn, or service position is terminated because of false statements, omissions, or answers made by myself on this application. In the event of acceptance in the AmeriCorps program, while holding a service position with this company, I will comply with all rules and regulations as set by the company and the AmeriCorps program in any communication distributed to the AmeriCorps service member.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company, and to the AmeriCorps program that verifies my right to work in the United States before enrollment in the AmeriCorps program. I have received from the company and the AmeriCorps program a list of the approved documents that are required.

I understand that an AmeriCorps service position at this company is contractual through the ARCD AmeriCorps program and the Corporation for National and Community Service, which means that I must meet all requirements set forth by the AmeriCorps program to hold a service position with this company and with the AmeriCorps.

I understand that a criminal history background check is required to be considered for this position. I agree to provide the company and the AmeriCorps program all requested identification documentation to carry out criminal background checks. Furthermore, I authorize the Appalachian RC&D Council to carry out these checks.

*I hereby acknowledge that I have read and understand the above statements. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and affect as a manual signature.