Lead to Read Application

BASIC INFORMATION

Name

First Name

Last Name

Have you gone by any other names? (first and last)

Are you a United States citizen, national, or lawful permanent resident alien?

Yes

If you are a lawful permanent resident alien and you received your card after January 1987, what is your registration number and card expiration date?

Which school are you interested in serving at?

Earliest date you are able to begin service:

CURRENT ADDRESS :

All information will be sent to this address unless your notify us of a change.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone:

(###)

###

####

Email:

EMERGENCY CONTACT:

First Name

Last Name

Relationship

Emergency Contact Phone Number:

(###)

###

####

Check the highest level of education that you will have completed by the time you are planning to serve in Lead to Read Jennings AmeriCorps?

Check only one

High School Diploma/GED

Technical School / Apprenticeship

Associate's Degree

Some College

Bachelor's Degree

Graduate Degree

Other

EMPLOYMENT HISTORY

You may email a resume instead if it addresses the information requested below.

Beginning with the most current or most recent position, list the last four positions your have held or your last ten years of employment history. Include self-employments, internships/fellowships, and full- or part-time paid or unpaid work experience.

1. Name and Address of Employer:

Dates Employed:

Job Title:

Duties:

Reason for Leaving:

2. Name and Address of Employer:

Dates Employed:

Job Title:

Duties:

Reason for Leaving:

3. Name and Address of Employer:

Dates Employed:

Job Title:

Duties:

Reason for Leaving:

4. Name and Address of Employer:

Dates Employed:

Job Title:

Duties:

Reason for Leaving:

SKILLS

Please provide any skills and experience that may be helpful in evaluating your application, including other languages spoken.