AmercorpsApp-Page1 – Lessie Bates Davis Neighborhood House

Applicant Information

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Phone Number:

Email Address:

Are you interested in Full Time, Part Time, or Quarter Time?

Will you be 18 years old or older at the start date of service?

Date of Birth:

Are you a US Citizen, national, or lawful permanent resident?

Education

Do you have a Diploma, GED, or HiSet

Year Awarded:

If Yes, from where?

Availability

Sunday:

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

If the above information is correct, type you name below and click on the button to the right to proceed to the next step of the application

Please type your full name below before proceeding to page 2.

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