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Virtual Tours
Belleville Campus Virtual Tour
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Information for...
High School Students
Prospective Students
Current Students
Former Students
About
Board of Trustees
Campuses
College Profile
Offices
Academics
Academic Standards
College Catalog
Find A Program
Find a Course
Online Learning
Career Degrees
Career Certificates
Transfer Degrees
Career Pathways
Community
Adult Education and Literacy
Belleville AmeriCorps
Community Education
Foundation
Library
The Schmidt Art Center
Senior Programs
Speakers Bureau
Career Services
Life at SWIC
Athletics
Blue Storm Radio
College Activities
Student Handbook
SWICarts
SWIC Dining Options
Student Services
Advising
SWIC Bookstore
Career Services
Enrollment Services
Library
Paying For College
Public Safety
Records
Success Center
Support Services
SWIC-Cares About You!
Testing Centers
Contact
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Belleville AmeriCorps Application Form
Position
I would like to be considered for the following position:
Full-time: 1,700 hours
Part-time: 900 hours
Quarter Time: 450 hours
Minimum (summer): 300 hours
Application Information
Name (Legal)
*
First
Last
Phone
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Email
*
Are you a U.S. citizen, national or lawful permanent resident alien?
*
Yes
No
Will you be 17 years old or older as of the start date of service?
*
Yes
No
Education
Please select the highest grade you have completed:
High School
*
9
10
11
12
GED
*
Yes
No
College
*
1
2
3
4
Graduate School
1
2
3
4
Beginning with ninth grade, list the educational institutions you have attended.
*
School/Institution
City/State
Dates Attended
Area of Study
Degree/Certificate
Date Received
Employment Record
Please describe your employment record. List the last five positions you have held. Be sure to include any experience you have which may be relevant to your service as a Belleville AmeriCorps member. You may send us a résumé if you wish.
*
Employer
Position
Dates
Reason for Leaving
Supervisor
Phone Number
Please click and type this information in the boxes below.
Are you currently on lay-off status, subject to recall?
Yes
No
Volunteer Experience
List and describe any volunteer experience and/or community involvement.
Activity Description
Organization
Dates
Availability
Please list the days and hours you are available to serve with Belleville AmeriCorps.
*
Personal Statement
Why do you want to participate in Belleville AmeriCorps?
*
What will you do, as a participant, to ensure the success of the Belleville AmeriCorps program?
Briefly explain how your professional, volunteer and educational experiences would be helpful to you as a Belleville AmeriCorps member.
Felony Convictions
Have you ever been convicted of a felony?
*
Yes
No
List
*
Type of Conviction
Date
Disposition
Optional Demographic Information
Ethnic Background
African American
White/Non-Hispanic
Hispanic/Latino
Asian American/Pacific Islander
American Indian/Alaskan Native
Other
Accomodations
Do you have any special needs that require accomodation?
Yes
No
If so, specify:
Public Assistance
Does your family receive public assistance (e.g. TANF, Food Stamps, Medical Card)?
Yes
No
If yes, please specify:
Household Information
Total annual household income from all sources
How many people reside in your household?
Date of Birth
MM slash DD slash YYYY
Certification of Application
The statements that I have made in this application are true and complete to the best of my knowledge and I understand that any alteration or concealment of a material fact will result in my disqualification before appointment or dismissal after appointment. I understand that Southwestern Illinois College is a drug-free workplace and that I must be drug-free at the time of appointment and throughout my term of service. I will be required to submit to a criminal background check. I hereby authorize Southwestern Illinois College or its representative to investigate my background, including but not limited to past employment, military and police records. My permission is hereby given to any and all persons, agencies, corporations, firms or associations to release any and all such information, records or other documents to Southwestern Illinois College or its representative for its inspection and copying. A copy hereof shall be considered equally authentic as the original.
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