AmeriCorps Application

If you are interested in becoming an Americorps member with the Rural Health Network of South Central New York, please complete the application below.  You must also submit the contact information for 3 references or 3 letters of recommendation that are employment, education or volunteer service related.  Applicants must be between the ages of 18 and 25.

 

Online Application Form
Please fill in the form below completely and click Send Application at the bottom.

Full Name
Age
Date Of Birth (MM/DD/YY)
Home (Permanent) Address
Street Address
City, State Zipcode
College Address (If Applicable)
Street Address
City, State Zipcode
Current Phone Number(s)
Email Address
Best Time To Contact You? (AM/PM)
Date You Are Available To Start?
Position
What Position Are You Applying For?
Why are you interested in serving with the Rural Health Network?


What are your career goals and plans?


What is your current educational level and what are your educational goals and plans?


Please list and describe your volunteer experience:


Please list and describe your work experience:


Have you ever served in an Americorps Program? If so, please describe:


Please tell us how you heard about the Rural Health Network Americorps Program:

Newspaper advertisement
College or high school placement or volunteer office
NYS Department of Labor
Newspaper Article
Corporation for National & Community Service Web Site
Friend or Colleague
Other (please describe)