Apply for AmeriCorps | Southwestern Illinois College

Belleville AmeriCorps Application Form

  • Position

  • Application Information

  • Education

    Please select the highest grade you have completed:
  • School/InstitutionCity/StateDates AttendedArea of StudyDegree/CertificateDate Received 
  • Employment Record

  • EmployerPositionDatesReason for LeavingSupervisorPhone Number 
    Please click and type this information in the boxes below.
  • Volunteer Experience

  • Activity DescriptionOrganizationDates 
  • Availability

  • Personal Statement

  • Felony Convictions

  • Type of ConvictionDateDisposition 
  • Optional Demographic Information

  • Do you have any special needs that require accomodation?
  • Does your family receive public assistance (e.g. TANF, Food Stamps, Medical Card)?
  • Total annual household income from all sourcesHow many people reside in your household?
  • Date Format: 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.