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Katrina Rebuild Project Application
* required information
YouthBuild AmeriCorps Katrina Rebuild Project Application
First Name:
*
Last Name:
*
Email:
*
Address Line 1:
*
Address Line 2:
City:
*
State:
*
-- please make a selection --
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Phone:
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Birth Date:
*
(mm/dd/yyyy)
YouthBuild Program:
*
Location of YouthBuild Program:
*
I have a:
*
GED
High school diploma
Name of current or most recent employer:
*
Address of current or most recent employer:
*
Your job title at current or most recent employer:
*
Dates of employment for current or most recent employer:
*
Name of previous employer:
Address of previous employer:
Your job title at previous employer:
Dates of employment for previous employer:
What are your specialized construction skills (e.g., HVAC, plumbing, electrical, masonry):
*
What are your other skills or talents (e.g., play an instrument, write poetry, tell stories, group skills):
*
Describe your leadership activities since you graduated from YouthBuild:
*
If no, by what date can you move:
(mm/dd/yyyy)
Are you willing to be drug tested:
*
Yes
No
Do you have any current unresolved issues (e.g. court, family, health) that would interfere with being part of this project?:
*
Yes
No
If yes, what:
Do you have any special medical conditions (e.g., allergies, diabetes, asthma, joint, back conditions)? If so, please specify.:
Any special dietary needs? If so, please specify:
Are you sending your required essay:
*
Yes
No
Are you sending your required letters of recommendation:
*
Yes
No
Are you sending your required copy of you birth certificate or certificate of naturalization:
*
Yes
No
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