Peace Corps Response Application

OMB Control Number:  0420-xxxx

Expiration Date:

Peace Corps Mission And Core Expectations

Prior to proceeding with the application process, please carefully read the Peace Corps Mission and Expectations. You will not be able to proceed until you have read and accepted the mission and expectations.

The mission of the Peace Corps is to promote world peace and friendship by:

• Helping people of interested countries in meeting their need for trained men and women

• Helping promote a better understanding of Americans on the part of peoples served

• Helping promote a better understanding of other peoples on the part of Americans


In working toward fulfilling the Peace Corps Mission, as a Response Volunteer, you are expected to:

1. Prepare your personal and professional life to make a commitment to serve abroad

2. Commit to improving the quality of life of the people with whom you live and work; and, in doing so, share your skills, adapt them, and learn new skills as needed

3. Serve where the Peace Corps asks you to go, under conditions of hardship, if necessary, and with the flexibility needed for effective service

4. Recognize that your successful and sustainable development work is based on the local trust and confidence you build by living in, and respectfully integrating yourself into, your host community and culture

5. Recognize that you are responsible 24 hours a day, 7 days a week for your personal conduct and professional performance

6. Engage with host country partners in a spirit of cooperation, mutual learning and respect

7. Work within the rules and regulations of the Peace Corps and the local and national laws of the country where you serve

8. Exercise judgment and personal responsibility to protect your health, safety, and well-being and that of others

9. Recognize that you will be perceived, in your host country and community, as a representative of the people, cultures, values, and traditions of the United States of America

10. Represent responsibly the people, cultures, values, and traditions of your host country and community to people in the United States both during and following your service

Core Expectation Acknowledgement

I have read these expectations and understand that I am responsible for meeting these expectations.

Eligibility Requirements

Thank you for your interest in serving as a Peace Corps Response Volunteer. Should you become a Peace Corps Response Volunteer, you will be undertaking an exciting and life-changing experience. No one may be invited to be a Peace Corps Response Volunteer unless he or she is a United States citizen and is at least 18 years old.

Are you a US citizen?

Yes

No

Additional Eligibility Requirements

Are you a returned Peace Corps Volunteer or do you have at least 10 years of professional experience?

Yes

No

General Questions

In addition to applying for this Peace Corps Response position, are you currently also applying to the two-year Peace Corps program?
Yes

No

How did you learn about Peace Corps Response?

Select One

Peace Corps Website

Regional Recruitment Office

Returned Peace Corps Volunteer career event

COS Conference

PCR Impact Newsletter

Hotline

Returned or Current Peace Corps Response Volunteer

Returned or Current Peace Corps Volunteer

Friend

Other

If other, indicate here

Upload Your Resume

Please upload your resume below. Some parts of your resume will automatically populate fields of the application. Please review those fields and edit as necessary.

Resume/CV

Choose one of the methods below to submit your resume/CV.

Use a resume/CV from my profile

Upload my resume/CV from my computer

Enter my resume/CV by typing or copying it in

Select the resume/CV you’d like to use

File to upload:

Name this resume/CV:

Enter the text of your resume/CV in the text box below.

Name this resume/CV:

Contact Information

Please make sure this page contains your most up-to-date information so you can be reached by Peace Corps Response staff. If this information changes, please be sure to let us know immediately through Edit Your Profile.

First Name

Middle Name

Last Name

Address line 1

Address line 2

Country

City

State/Region/Province

Zip/Postal Code

Primary Phone

Alternative Phone

Other Phone (e.g., mobile)

Contact e-mail address

Fax

Web Address

What is your gender?

Male

Female

Date of Birth

Education

Please review the completed fields for your education to ensure that the information is accurate. Prior to moving on to the next page of your application, you will be required to select the “most recent” school that you attended.

School or Educational institution

Major or Area of study

Degree

Associates

Bachelors

Doctorate

JD

Masters

MBA

MD

Other

GPA

Grad year

Most recent

Actions

Employment History

Please review the completed fields for your employment history to ensure that the information is accurate. Prior to moving on to the next page of your application, you will be required to select your “most recent” job.

Position or job title

Organization name

Start year

End year

Most recent

Actions

Peace Corps Service History

Peace Corps Response countries and the partner organizations with which they collaborate, request candidates who have experience in a culturally diverse environment and who have the needed technical expertise and language skills. In order to fulfill this request, candidates for Peace Corps Response must have at least 10 years professional experience or be a returned Peace Corps Volunteer (RPCV).

Do you have previous Peace Corps service?

Yes

No

Peace Corps Service History (Continued)

What is your most recent Peace Corps/Peace Corps Response country of service?

What years did you serve there? (MM/YYYY to MM/YYYY)

If you have additional Peace Corps/Peace Corps Response service, please list the countries and dates below.

Cross-Cultural Essay

*Your success as a Peace Corps Response Volunteer is based on the trust and confidence you build by living in and respectfully integrating yourself into your host community and culture. Describe an experience you have had living or working in a socio-economic or cultural environment different from your own. What specific challenges did you face concerning trust, confidence, and/or integration? What did you learn from this experience that you will bring with you to your Peace Corps Response service? (2 to 3 paragraphs/maximum 4,000 characters)

Skills

Because Response Volunteers are expected to deliver tangible results in a condensed period of time, competitive applicants will have the necessary language, technical, and cross-cultural skills needed for the position. To ensure your application is as strong as possible, please respond to the job-specific question(s) below.

This section may auto-populate based upon answers that you have submitted with a previous application. Please verify that your answers are specific to the position for which you are applying, as your competitiveness for the project may be evaluated based upon your response.

How do your skills qualify you for this specific position?

Language Skills

Please prioritize the languages that are most relevant for the position for which you are applying. Additionally, please indicate the level of verbal proficiency for each language selected. If you do not see the language(s) that you speak in the list provided, please select the “other” option at the bottom of the list, write in the language, and indicate your level of verbal proficiency.

Language 1 (this list contains 218 of the most commonly-used languages, including the languages listed below)

Arabic

Bulgarian

French

Georgian

Malagasey

Portuguese

Russian

Spanish

Skill Level

Basic

Intermediate

Conversational

Fluent

Language 2 (this list contains 218 of the most commonly-used languages, including the languages listed below)

Arabic

Bulgarian

French

Georgian

Malagasey

Portuguese

Russian

Spanish

Skill Level

Basic

Intermediate

Conversational

Fluent

Language 3 (this list contains 218 of the most commonly-used languages, including the languages listed below)

Arabic

Bulgarian

French

Georgian

Malagasey

Portuguese

Russian

Spanish

Skill Level

Basic

Intermediate

Conversational

Fluent

If Other, please indicate language

Marital Status

Are you married?

Yes

No

Are you applying to serve with your spouse?

Yes

No

If answer, yes -

It is possible for Peace Corps Response Volunteers to serve together as a married couple, but only if available projects exist for which both partners can qualify. Both you and your spouse would need to qualify for assignments in the same location in order to serve together.

If you are selected for an interview, a Peace Corps Response recruiter will follow-up with you in greater detail regarding your desire to serve with your spouse. Please click “next” to proceed in the application.

If answer, yes -

Would you also be willing to serve without your spouse?

Yes

No

Dependents

If you are considering service and you have dependents, you will be required to complete a questionnaire that asks you to consider the challenges associated with being separated from your dependents.

Do you have any dependents?

Yes

No

If yes, how will you support them?

Military History

Have you ever served with any branch of the U.S. Armed Forces?
Yes

No

If yes, what branch? (list branch and dates)

Legal History

If you fail to disclose any required information regarding legal, financial, or drug and alcohol behavior, Peace Corps Response may revoke your invitation to serve, or disqualify you from service in Peace Corps Response. Any misleading, inaccurate, or incomplete information may be cause for disqualification or termination. In addition, any intentionally false statement may be subject to fines and/or imprisonment pursuant to 18 U.S.C. Section 1001. Peace Corps Response reserves the right to ask additional questions about drug and alcohol use.

In order to verify your responses to legal history questions, you will be subject to a National Agency Check (NAC). The NAC is a criminal background investigation conducted by the United States Office of Personnel Management (OPM).  The NAC investigation consists of a search of OPM’s Security and Suitability Investigations Index (SII), the Defense Clearance Investigations Index (DCII), a Federal Bureau of Investigations (FBI) name check, and a FBI National Criminal History fingerprint check. The NAC background investigation is typically initiated after an applicant is invited to serve in a Peace Corps program.

The existence of an arrest or conviction record will not automatically exclude an applicant from consideration for service in Peace Corps Response. When evaluating an applicant’s arrest or conviction information, Peace Corps Response considers the nature of the offense(s), how long ago the offense(s) occurred, the nature of the position in question, and other relevant facts or indicia of rehabilitation. If an applicant is ultimately rejected for the Peace Corps Response position because of an arrest or conviction in his or her background, the applicant has the opportunity to appeal the decision.

Have you been arrested, charged, or convicted of any offense by a civilian or military court or have you been subjected to any disciplinary action by a military court or tribunal? (Include misdemeanors, felonies, and all drug and/or alcohol related legal incidents. Do not include traffic violations for which the sentence consisted only of a fine of $300 or less unless the incident involved drugs and/or alcohol).

Yes

No

If yes, please provide a brief explanation of the type of each offense and the dates that each occurred.

Intelligence Activities and Organizations

It has been the Peace Corps' longstanding policy to exclude from Peace Corps Volunteer service, in accordance with Peace Corps Manual Section 611, any persons who have engaged in intelligence activity or related work or who have been employed by or associated with an intelligence agency.

The policy is founded on the premise that it is crucial to the Peace Corps in carrying out its mission that there is a complete and total separation of the Peace Corps from the intelligence activities of the United States government, both in reality and appearance. Any semblance of a connection between the Peace Corps and the intelligence community would seriously compromise the ability of the Peace Corps to develop and maintain the trust and confidence of the people of the host countries. Serious doubts about an applicant's connection with intelligence activities are to be resolved in favor of exclusion.

"Intelligence Activity" includes any activities or specialized training involving or related to the clandestine collection of information, or the analysis or dissemination of such information, intended for the use by the United States government in formulating or implementing political or military policy in regard to other countries. The term "intelligence activity" includes any involvement in covert actions designed to influence events in foreign countries.

Persons currently or formerly employed by the Central Intelligence Agency are permanently ineligible for Peace Corps Volunteer service. Employment with other intelligence agencies may also be disqualifying. In addition, applicants may be disqualified for service because their background or history discloses a substantial connection with an intelligence activity or related work other than through employment. Even familial relationships to an employee of an intelligence agency may be considered a disqualifying connection. If you have a family member who works for or has worked for the CIA, you should not complete the intelligence background questionnaire until your family member has consulted with the CIA’s Office of General Counsel.  Be advised for security reasons, you may only contact your CIA family member concerning your Peace Corps application in person (i.e. not by email, phone, social networking, or any other means that is not in person).

Depending upon the nature of an applicant's involvement in or relationship to intelligence activities or agencies, the duration of disqualification may range from a permanent disqualification, disqualification up to ten years or disqualification for ten years or more. Applicants are also advised that service as a Peace Corps Volunteer may result in disqualification from employment with intelligence agencies of the U.S. Government for periods following service as a Volunteer.

In some cases, employment or association with certain intelligence activities or agencies will result in the Peace Corps instructing you to contact those agencies who will coordinate with the Peace Corps, as necessary and appropriate, to assist the Peace Corps in rendering a final decision on your application.

If you indicate that either you or a family member has been employed by or connected to an intelligence agency, or engaged in intelligence activity or related work, a representative from Peace Corps Response will contact you for additional information to determine if you are eligible to become a Peace Corps Response Volunteer.

After receiving and accepting an invitation to serve as a Peace Corps Response Volunteer, you will be required to withdraw all applications for employment with intelligence agencies and supply the Peace Corps with a copy of the letter to each agency requesting the withdrawal of your application.

Have you or a family member ever been employed by or connected with an intelligence agency, or engaged in intelligence activity or related work?

Yes

No

Are you currently applying for employment or an internship with any intelligence agency or other organization associated with intelligence activities?

Yes

No

Request For Racial And Ethnic Data (Optional)

Please check one of the classifications in the Ethnicity section below.

Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term “Spanish” origin can be used in addition to “Hispanic” or “Latino”)

Not Hispanic or Latino

Please check one or more of the classifications in the Race section below.

White (a person having origins in any of the original peoples of Europe, the Middle East, or North Africa)
American Indian or Alaska Native (a person having origins in any of the original peoples of North and South America [including Central], and who maintains tribal affiliation or community attachment)
Asian (a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam)
Black or African American (a person having origins in any of the black racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black” or “African American”)
Native Hawaiian or Other Pacific Islander (a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands)

Privacy Act Notice

Privacy Act and Paperwork Reduction Act Notice

The Peace Corps, an agency of the federal government, is required by the Privacy Act of 1974 (5 U.S.C. 552a) to advise you of the following information regarding this application. The Privacy Act addresses the federal government’s use of certain personal information in agency files.

A. This application is authorized by the Peace Corps Act (22 U.S.C. 2501 et seq.).

B. The principal purpose for which the information provided will be used is to evaluate your suitability and qualifications to serve as a Peace Corps Response Volunteer.

C. Information in this application may routinely be disclosed as follows: • To Peace Corps staff and contractors who have a need for the information in performance of their duties; • To host country officials for the purposes of obtaining visas and determining program placement; • To your family or next-of-kin so that you may be located in case of emergency; • In compelling circumstances affecting your health and safety; • To Congressional offices in response to an inquiry made at your request, or to Congress as requested; • To a U.S. Ambassador or designee in a country where the Peace Corps serves when the information is needed to perform an official responsibility, to respond to official inquiries and deal with in-country situations that are within the scope of the Ambassador’s responsibility; • As required under the Freedom of Information Act; • To a court or other judicial body as appropriate; • To the Department of Treasury and other federal agencies for use in connection with support payments, tax matters and Social Security; • To verify active or former Volunteer service; • In the case of United Nations Volunteers, to appropriate U.N. officials; • To law enforcement agencies as appropriate; • As necessary to obtain information relevant to a security clearance; • To federal agencies having a need to verify Volunteer eligibility for federal employment; • To the U.S. Office of Management and Budget in connection with private relief legislation; • To the Department of Justice and others for litigation purposes; • To the National Archives and Records Administration for records retention and records management inspections; • To the U.S. Office of Personnel Management in connection with their evaluation and oversight of federal personnel management; • To the Bureau of the Census for census purposes; • Without personal identifiers, for statistical purposes; • To the Comptroller General in the performance of the duties of the Government Accountability Office.

D. The completion of this form is voluntary. However, the failure to do so will result in the Peace Corps being unable to assess your qualifications and result in non-selection for the Peace Corps Response position for which you have applied.

E. Public reporting burden for this collection of information is estimated to average 60 minutes per response. This estimate includes the time for reviewing instructions and completing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: FOIA Officer, Peace Corps, 1111 20th Street, NW, Washington, DC 20526 ATTN: PRA (0420-####). Do not return the completed form to this address.

PLEASE NOTE: The Peace Corps does not discriminate based on race, color, national origin, religion, age, sex, handicap, political affiliation, or sexual orientation. Anyone who feels he or she has been discriminated against should contact the Peace Corps American Diversity Office, 1111 20th Street, NW, Washington, D.C. 20526.

I hereby authorize the Peace Corps and other authorized Federal agencies to obtain any information required from the Federal government and/or state agencies, including but not limited to, the Federal Bureau of Investigation (FBI), the Defense Investigation Service (DIS), the U.S. Office of Personnel Management (OPM), the U.S. Department of Homeland Security (DHS), (if applicable). This authorization is valid for one year from the date this form was signed.

I have been notified of any Peace Corps’ right to require a criminal history records check as a condition of Volunteer service. I understand that I may request a copy of such records as may be available to me under the law. I understand that I have a right to challenge the accuracy and competencies of any information contained in the report. I also understand that this information will be treated as privileged and confidential information. Case files are handled under the procedures for safeguarding records.

I release any individual, including records custodians, any component of the U.S. Government or the individual State Criminal History Repository supplying information, from all liability for damages that may result on account of compliance, or any attempts to comply with this authorization. This release is binding, now and in the future, on my heirs, assigns, associates, and personal representative(s) of any nature. Copies of this authorization that show my signature are as valid as the original release signed by me.

Confirmation

I certify that all of the statements on all pages of this application, including attachments, are true, correct, and complete to the best of my knowledge and are made in good faith. I understand that any misleading, inaccurate, or incomplete information may be cause for disqualification or termination from Peace Corps Response service. In addition, any intentionally false statement or intended omission may be subject to fines and/or imprisonment pursuant to 18 U.S.C. 1001. I also understand it is my responsibility throughout the application process to inform the Peace Corps promptly of any changes to the information provided in this application.

Final determinations on applicants’ eligibility and suitability for a Response position are the responsibility of the Peace Corps. You will be provided the opportunity personally to explain refute, or clarify any information before a final decision is made.

Signature Line (Name)

Today’s Date

Thank You

Thank you for your interest to serve through Peace Corps Response. If you are selected to serve as a Peace Corps Response Volunteer, you will be undertaking an exciting and life-changing experience. We look forward to reviewing your application and thanks again for considering Peace Corps Response.