Form

Mile High Youth Corps Application
Application Date
Field Location*

Denver Colorado Springs No Preference
Position Applied For*
Are you between 18 and 24 years old?*

Yes No
General Information
Full Name*
Email Address*
Street Address
City
State
Zip Code*
Phone Number*
Alternate Phone Number
Date of Birth*
Age*
Have you ever applied here before?

Yes No
Have you ever worked here before?

Yes No
If yes, when and for what crew?
How did you hear about Mile High Youth Corps?*
Can you submit proof of your eligilbity to be lawfully employed in the United States?

Yes No
Employment History
1. Company Name
Address
Phone Number
Job Title/Position
Dates of Employment (From - To)
Responsibilites/Duties
Reason for Leaving
2. Company Name
Address
Phone Number
Job Title/Position
Dates of Employment (From - To)
Responsibilities/Duties
Reason for Leaving
References
1. Name
Phone Number
Occupation
Relationship to applicant
2. Name
Phone Number
Occupation
Relationship to applicant
3. Name
Phone Number
Occupation
Relationship to applicant
General
Have you, in the last 7 years been convicted of a crime?

Yes No
Is there anything that would prevent you from performing the essential job functions in a reasonable and safe manner for the position for which you have applied? If yes, please explain.
Have you ever received an AmeriCorps Education Award or been enrolled in AmeriCorps program before? If so, where and when?
Do you currently reside in the 15 county region of Colorado served by Mile High Youth Corps? The 15 counties include: Adams, Arapahoe, Broomfield, Custer, Denver, Douglas, Elbert , El Paso, Fremont, Gilpin, Huerfano, Jefferson, Las Animas, Pueblo, & Teller.*

Yes No
How long have you lived in the 15 county region served by MHYC?*
Demographics (optional)
Gender
Ethnicity
Education and Training
Have you earned your high school diploma or GED?*

Yes No In process
High School Name
Diploma received & date
College/Vocational School Name
Diploma or degree received & date
Do you have any relevant certifications? (Such as First Aid/CPR, OSHA-10, S212)

Yes No
Please list any certifications you have:
Short Answer Questions
1. Please tell us why you want to become a member of Mile High Youth Corps:
2. What is one hope or dream you have for your future?
3. Tell us about a personal quality, talent, accomplishment, contribution or experience that is important to you.
4. Please describe a time you helped out in your community or helped a member of your community.
5. What are some of your interests? Please list.
Read before signing - Enter your full name for each statement to serve as an e-signature.
1. I affirm that all of the information provided in this application is true and accurate. I understand that the falsification of any information may be cause for immediate termination from Mile High Youth Corps in the event that I am hired.*
2. If I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to admit such proof within the required time will result in termination of my employment.*
3. In processing my application for employment, I authorize Mile High Youth Corps and/or its agents to verify all answers, statements and information provided by me. I heereby release Mile High Youth Corps from any and all liability for any damage whatsoever arising from investigating and verifying the referenced information.*
4. If I am employed, I am able to fully commit to serving the entire length of the term and maintain a minimum of 90% level of attendance.*
Should be Empty:

Mile High Youth Corps Application

General Information

Employment History

References

General

Demographics (optional)

Education and Training

Short Answer Questions

Read before signing - Enter your full name for each statement to serve as an e-signature.