Form PC-DP-969.1.2 Career Information Consultants Waiver Form

Dear Prospective Career Information Consultant:

Thank you for your interest in serving as a resource in the Career Information Consultants Directory (CIC). The publication is updated annually.

We are now in the process of preparing the 2007 edition of the directory and welcome your support. If you are interested in being listed in this edition, please take a moment to complete the enclosed waiver form and return it in the self-addressed stamped envelope.

If for some reason, you are unable to participate in the Career Information Consultants project at this time, please complete the section below and return this letter in the self-addressed stamped envelope.

Please return this signed letter or the completed form by October 30, 2007.

Thanks again for your involvement in this project. Your time, expertise, and readiness to assist in the job search process of the RPCV community are invaluable assets. Please let me know if you have questions regarding your listing, please contact me for assistance or if you would like information about additional RPCV career activities and events. I can be reached at (202) 692-1435 or by e-mail at [email protected]

Take Care,

Tamara Webb, Program Specialist

Office of Domestic Programs

Returned Volunteer Services

I am unable to serve as a Career Information Consultant (CIC) at this time. Please do not include my name and contact information in the 2007 edition of the Career Information Consultants directory.
Name
Title or Position
Organization
Home Address		Work Address
Home Phone		Work Phone
Fax:		E-mail address

• Please check this box if you would like to be contacted regarding the CIC project in the future

Date

Signature

B

OMB Control No: 0420-0531

Expiration Date:

e a Career Information Consultant (CIC) for RPCVs!

Career Information Consultants (CICs) help current Peace Corps Volunteers and returned Peace Corps Volunteers with their career-related transition back to the United States. CICs assist by offering information about their career field, their past or current employer(s), and their career and educational paths. The Career Information Consultants directory is a project managed by the Peace Corps Office of Domestic Programs, Returned Volunteer Services (RVS).

CIC Qualifications/Expectations:

• Are you up-to-date on the trends and opportunities in a particular career field or agency?

• Do you agree to respond promptly to PCV and RPCV inquiries by letter, e-mail, or phone? Time commitments are usually minimal (averaging 2-10 contacts per year)

I qualify as a Career Information Consultant in the following career field(s):(indicate any specialty) If your career field is not listed on the reverse, please list.	1.		2.		3.
	4.		5.		6.

PLEASE PRINT CLEARLY

Please choose one of the following designations:

New CIC

Past or Current CIC

Name

Title or Position

Organization

Home Address

Work Address

Home Phone

Work Phone

Fax:

E-mail address

Where would you prefer to be contacted?

Home

Work

Are you a returned Peace Corps Volunteer (RPCV)?

Yes

No

If yes, where did you serve?

From (yyyy):

To (yyyy):

• I understand that the information I provide will be printed in a directory and shared with current and returned Peace Corps Volunteers.

• I understand that offering to serve as a CIC is on a voluntary basis and any expenses incurred (phone calls, postage) will be at my own expense.

• I understand that the publication will be updated annually. Waiver forms will be sent to all CICs each year.

Please date and sign this waiver form and return to:

Career Information Consultants Paul D. Coverdell Peace Corps Headquarters Office of Domestic Programs - Returned Volunteer Services 1111 20th Street, NW Washington, DC 20526 Fax: (202)692-1421 E-mail: [email protected]

Date		Signature

AGRICULTURE, ANIMAL, & ENVIRONMENTAL WORK
	Agricultural Education
	Agricultural Support Services
	Animal Production (Specify)
	Crop Production (Specify)
	Energy Science
	Environmental Consulting
	Environmental Education
	Environmental Project Admin
	Farm Management
	Fishing
	Forestry/Logging
	Parks and Zoos
	Natural Resource Management
	Veterinary Services
	Water Systems
	OTHER (Specify)

ARCHITECTURE, DESIGN & ENGINEERING
	Architecture
	Design (Specify i.e. Industrial.)
	Engineering Services (Specify)
	Landscape Services
	OTHER (Specify)

ARTS & ENTERTAINMENT
	Outdoor Recreation
	Museums
	Music Production
	Performing Arts (Specify)
	Travel & Tourism
	Visual Arts (Specify)
	OTHER (Specify)

BUSINESS, LAW, FINANCE & INSURANCE
	Accounting
	Banking
	Business Development
	Finance
	Financial Planning/Analysis
	General Business Admin.
	Human Resources
	Insurance
	Law & Legal Services
	Management Consulting
	Micro-enterprise
	Real Estate
	Sales
	Small Business Development
	OTHER (Specify)

EDUCATIONAL SERVICES (Specify Specialty or Dept if applicable )
	Adult Education
	Bilingual Education
	Colleges & Universities
	Community College
	Early Childhood Education
	Educational Administration
	Educational Counseling/
	Elementary Education
	English as a Second Language
	International/Global Education
	Secondary Education
	Special Education
	Substitute Teaching
	Vocational Education
	OTHER (Specify)

GENERAL NONPROFIT WORK
	Advocacy & Public Outreach
	Evaluation & Research
	Fundraising
	General Program Management
	Leadership Development
	Partnership Development
	Staffing
	Volunteer Management
	OTHER (Specify)

GOVERNMENT SERVICE & PUBLIC ADMINISTRATION (specify agency or title, if applicable)
	City/Urban/Regional Planning
	Community Development
	Crisis Prevention & Response
	Economic Development
	Environmental Policy
	Executive & Legislative Bodies
	Government Agencies
	__ Federal __ State __ Local
	Grants Administration
	Housing Authorities
	Immigration & Refugee Work
	Judicial Administration (Specify)
	Law Enforcement
	Lobbying Services
	Political Consulting
	Public Finance Administration
	OTHER (Specify)

HEALTHCARE & SOCIAL ASSISTANCE
	Addiction Counseling (Specify)
	Adoption
	Ambulatory Care
	At-Risk Youth Services
	Child Care
	Chiropractic Services
	Clinical Research
	Crisis Counseling
	Dentistry
	Disability Services
	Emergency Services
	Family Counseling
	Family Planning
	Global Health
	Healthcare Administration
	Health Education
	HIV/AIDS Education & Services
	Home Healthcare & Hospice
	Medical Research
	Mental Health
	Nursing Care – Other (specify)
	Nursing/Nurse Practitioner
	Nutrition
	Outpatient Care
	Peace & Conflict Resolution
	Physicians (specify)
	Public Health
	Social Work
	Vocational Rehabilitation
	Women’s Services & Support
	General Youth Services
	OTHER (Specify)

INFORMATION & COMMUNICATIONS
	Advertising
	Broadcast Communications
	Computer Programming
	Information Technology
	Journalism
	Language Interpretation
	Marketing (Specify)
	Public Relations
	Publishing (Specify)
	Telecommunications
	Television Production
	Video Production
	Web Development
	Writing & Editing
	OTHER (Specify)

OTHER CAREERS
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_	_______________________
_	_______________________
_	_______________________
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_	_______________________

PC-DP-969.1.2 (Rev. 02/07)