OMB 0420-0005 Peace Corps Volunteer Application

Peace Corps Application

October 2016

Contents

Privacy Act 3

Start Your Application 4

Citizenship 4

Age Requirement 5

Contact Information 5

Current Mailing Address 5

Upload Your Resume 6

Previous Peace Corps History 7

Peace Corps Staff Reference 7

Couples 7

Spouse/Domestic Partnership 7

Declaration of Domestic Partnership 8

Dependents 9

Dependent Information 9

Military Obligations 9

Legal History 9

Legal Offense 10

Final Court Judgment 11

Probation 11

Additional Incidents 11

Drug and Alcohol Policy 11

Drug and Alcohol Use by Volunteers and Trainees Overseas 12

Intelligence Background 12

Education 13

Master’s International 14

Master’s International Information 14

Peace Corps Prep 14

Peace Corps Prep Information 15

Foreign Language Skills 15

Motivation Statement 16

References 16

Reference 1 16

Reference 2 16

Request for Racial and Ethnic Data 16

Ethnicity 17

Race 17

Certification 17

Review 17

Privacy Act

The Peace Corps, a U.S. government agency, 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.) as amended. 

B. The information you provide will be used to evaluate your suitability and qualifications to serve as a Peace Corps Volunteer. 

C. This information may be used for the routine uses described in the Privacy Act, 5 U.S.C. 552a, and the Peace Corps' published Routine Uses, summarized in Peace Corps' System of Records. 

D. The completion of this application is voluntary. However, failure to complete the application will result in the Peace Corps’ inability to assess your qualifications and may preclude your consideration for the Peace Corps. 

E. The Peace Corps asks for your Social Security number because the Peace Corps Act, 22 U.S.C. 2519, requires us to do a background check on all Volunteers. The Peace Corps will also use it to ensure our records are accurate for tax and other financial and accounting purposes. 

Paperwork Reduction Act Burden Statement: Public reporting burden for this information collection is estimated to average one hour. This includes the time for reviewing instructions and completing the information. This is voluntary information collection. An agency may not conduct or sponsor, and persons are 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: the FOIA Officer, Peace Corps, 1111 20th Street, NW, Second Floor, Washington, DC 20526. 

PLEASE NOTE: The Peace Corps does not discriminate based on race, color, religion, sex, national origin, age (over 40), disability, sexual orientation, gender identity, gender expression, marital status, parental status, political affiliation, union membership, genetic information, or history of participation in the EEO process, any grievance procedure, or any authorized complaint procedure. Anyone who feels he or she has been discriminated against should contact the Office of Civil Rights and Diversity, 202.692.2139, [email protected], 1111 20th Street, NW, Washington, DC 20526.

Start Your Application

Thank you for your interest in serving as a Peace Corps Volunteer. Should you become a Peace Corps Volunteer, you will be undertaking an exciting and life-changing experience. To be eligible to serve in the Peace Corps, you must 

• be a U.S. citizen (or have made satisfactory arrangements to be naturalized prior to your service) and

• be at least 18 years old prior to your start of service.

In addition to these basic eligibility requirements and the Peace Corps’ overall evaluation of applicant suitability for service, Peace Corps service is dependent on applicants meeting certain standards relating to medical and legal status eligibility.

PLEASE NOTE: Any intended omission or intentionally false statement that you submit as part of this application may constitute a violation of federal and state laws and result in severe civil and criminal penalties, including fines and/or imprisonment pursuant to 18 U.S.C. 1001. Furthermore, it is your responsibility throughout the application process, up through the start of service, to inform the Peace Corps promptly of any changes to the information provided here. Failure to do so may be cause for disqualification or termination of Peace Corps service.

OMB Control Number:

Expiration Date:

Privacy Act Notice

Citizenship

*Are you a U.S. citizen (by birth or naturalization)?

• Yes

• No

If you are a naturalized U.S. citizen, please note that some countries prohibit Volunteers with dual citizenship from utilizing their U.S. passports. However, to ensure Volunteers’ safety and security, the Peace Corps requires all Volunteers to utilize their U.S. passport during service. Before applying to a country in which you have dual citizenship (including nationality bestowed by place of birth), please carefully research any restrictions that may preclude you from service in that country.

* If you are selected, your service would begin within the next 12 months. Do you expect to become a naturalized citizen or have made arrangements to be naturalized in the next 12 months?¹

• Yes

• No²

Age Requirement

* Will you be at least 18 years of age prior to the anticipated start date of service?

• Yes

• No³

Contact Information

You must provide your full name as it would appear on a legal document (e.g., passport, driver’s license, birth certificate). The use of one email address throughout the application process is recommended. We suggest using a permanent email address, as opposed to a school or work email address.

*First name (your legal/given name)

Middle name (not initial)

*Last name

Suffix (Jr., Sr., etc.)

Nickname

* Have you ever used a different name?

• Yes

• No

*Other name⁴

*Dates used (Month/year to month/year)

* Have you used any additional names?⁵

• Yes

• No

*Primary phone

Secondary phone

*Permanent email address

*Social Security number (###-##-####)

*Please reenter your Social Security number (###-##-####)

*Sex

• Male

• Female

*Date of birth (m/d/yyyy)

Place of birth

*City

*County

*State

*Country

Current Mailing Address

You must be able to collect mail from this address in a timely manner following your application submission.

*Address line 1

Address line 2

*Country

*City

*State/Region/Province

*Zip/Postal Code

Upload Your Resume

Your resume is your opportunity to introduce yourself as a serious applicant for Peace Corps service. Moreover, your resume will be assessed to determine your qualifications for the position for which you are applying.

When creating your resume, we recommend the following:

• Review the required and desired skills for the position to which you are applying and tailor your resume to include relevant experience.

• Be comprehensive. Your resume should be one to three pages in length and should include relevant work, volunteer, and leadership experience. If you are a recent graduate, list relevant high school and/or college volunteer or work experience.

• Quantify your experiences. Include the number of hours spent tutoring, the length of a study abroad experience, or the time commitment for volunteer and internship experiences. For example: ABC Nonprofit, Intern: January – May 2017, 15 hours/week.

• Detail your education to include your degree, major, minor, GPA, and date of graduation or expected graduation, if applicable.

• Upload your transcripts as a supplement to the application in the applicant portal, which can be accessed after submitting an application.

By uploading your resume, you agree to permit the Peace Corps to share the information in it with host country agencies and counterparts, other Volunteers, and others the Peace Corps deems necessary or appropriate in connection with your application or possible future Peace Corps service. To best supplement your application, please upload your transcripts in the attachments section of your application.

Resume/CV

• Add resume/CV

• Use my profile as my resume/CV

Previous Peace Corps History

*Have you ever served as a Peace Corps trainee, Peace Corps Volunteer, or Peace Corps Response Volunteer?

• Yes

• No

*Are you a Returned Peace Corps Volunteer who completed service within the past five years? ⁶

• Yes

• No

Peace Corps Staff Reference⁷

Peace Corps trainees, Volunteers, and Peace Corps Response Volunteers who served within the last five years are required to submit a supervisory reference from a Peace Corps staff member from their country of service. If you are selected for an interview with the Peace Corps, we will contact your references at that time.

*Reference name (first and last name)

*Country of service

*Email address

Couples

The Peace Corps makes efforts to place married couples and domestic partners who wish to serve together. Please be aware that the opportunities to place couples are more limited than those for individual candidates. In order to serve together, both spouses/domestic partners must apply at the same time and qualify for assignments in the same country.

*Are you married or in a domestic partnership, or planning to be married or in a domestic partnership at the time you begin your service?

• Yes

• No

For additional information on serving as a couple, visit peacecorps.gov/legalinfo.

Spouse/Domestic Partnership⁸

*First name of spouse/domestic partner

Middle name of spouse/domestic partner:

*Last name of spouse/domestic partner:

*Are you planning to serve with your spouse or domestic partner?

• Yes, I am planning to serve with my spouse

• Yes, I am planning to serve with my domestic partner

• No

Declaration of Domestic Partnership⁹

Please read and confirm the statements below to support your indication that you plan to serve with your domestic partner.

My partner and I:

1. are each other’s domestic partner and intend to remain committed to one another indefinitely,

2. share responsibility for a significant measure of each other’s common welfare and financial obligations,

3. are not married to, joined in civil union with, or domestic partners with anyone else,

4. are not related in a way that would prohibit legal marriage in the state in which we reside.

5. agree to notify the Peace Corps of any dissolution of the domestic partnership not later than 15 days after the date of dissolution of the domestic partnership,

6. We understand that falsification of information within this affidavit may constitute a criminal violation under 18 U.S.C. 1001 and may lead to disciplinary action, and¹⁰

• have a common residence, and intend to continue the arrangement; or

• would have a common residence, but are prevented from having one due to the following circumstances (please explain below). ¹¹

Explanation if you do not currently share a common residence:

*I declare under penalty of perjury that the preceding is true and correct.

• Yes

Signature and date

For additional information on serving as a couple and the required legal documentation, visit peacecorps.gov/legalinfo.

Dependents

Serving as a Peace Corps Volunteer with dependents at home or elsewhere is often a challenge. For additional information on dependents, visit peacecorps.gov/legalinfo.

*Are any persons partially or totally dependent upon you for support, whether or not they are living with you?

• Yes

• No

Dependent Information¹²

*Name of dependent

*Dependent’s date of birth (m/d/yyyy)

*Do you have an additional dependent?¹³

• Yes

• No

Military Obligations

• *Are you a veteran or currently serving in the military? Yes

• No

* Do you have any military, reserve, or National Guard obligations?¹⁴

• Yes

• No

For more information regarding military obligations, visit peacecorps.gov/legalinfo. 

Legal History

The existence of an arrest or conviction record will not automatically exclude you from consideration for Peace Corps service. When evaluating an arrest or conviction, the Peace Corps considers the nature of the offense, how long ago the offense occurred, whether you were acquitted of the offense, and other relevant facts or indications of rehabilitation. If you are ultimately rejected for a Peace Corps Volunteer position because of an arrest or conviction, you can request a review of the decision and/or reapply at a later date. 

All Peace Corps invitees must undergo a background check that will disclose all arrests and convictions, regardless of whether the arrest or conviction has been expunged from your record. Recent drug- or alcohol-related legal issues may be a disqualifying factor for Peace Corps service. For more information about the drug and alcohol policy, background check and policies on arrests and convictions, go to peacecorps.gov/legalinfo. 

It is your responsibility to inform the Peace Corps promptly throughout the application process of all new arrests, charges, citations, misdemeanors, and felonies (including ALL drug- or alcohol-related legal incidents) and any other changes to the information provided below, including the disposition of existing offenses. Do not include minor traffic violations, citations, or parking tickets.

*Are you currently involved in any court proceedings (civil or criminal) that will require your participation (as a plaintiff, defendant, or witness) during the time you would be serving as a Peace Corps Volunteer?

• Yes

• No

*Have you ever been cited for, arrested, charged with, or convicted of any offense? Exclude minor traffic violations, citations, and parking tickets.

• Yes

• No

Legal Offense¹⁵

*Type of offense (e.g., DUI, possession of marijuana, petty theft)

*Date of incident (m/d/yyyy)

*Location of incident

*Give a complete narrative explanation of the circumstances surrounding the incident. The narrative should comprehensively explain what happened leading up to the incident, what happened during the incident, and how the incident was resolved.

*Was there a final court judgement?

• Yes

• No

Final Court Judgment¹⁶

*List all penalties including sentence, probation, community service, fines or other penalties imposed:

*Judgment date (m/d/yyyy)

*Current status or disposition¹⁷:

*Are you currently on probation of any kind?

• Yes

• No

Probation¹⁸

*What are the current requirements of your probation?

*Please state when and how your probation obligations will be met:

Additional Incidents

*Do you have any other legal incidents to report?¹⁹

• Yes

• No

Drug and Alcohol Policy

An applicant with any drug-related conviction or with a conviction for public intoxication, driving under the influence (DUI), or driving while intoxicated (DWI), with a conviction for reckless driving after having been initially charged with DUI or DWI, or who has a similar alcohol-related conviction, will not have his or her application for Peace Corps service considered until 12 months has passed from the date of the incident. The Peace Corps may deem an applicant unsuitable for Peace Corps service due to drug abuse, problem drinking, and/or alcohol abuse.

An applicant who, at any time on or prior to the day of departure for Peace Corps service, is arrested for any drug offense or for public intoxication, DUI, DWI, or any similar alcohol-related offense will have any pending application or invitation for Peace Corps service withdrawn. If the charges are dismissed, an applicant whose application or invitation for Peace Corps service was terminated may immediately reapply. If the applicant is convicted of the offense, he or she may reapply after 12 months from the date of the incident.

Drug and Alcohol Use by Volunteers and Trainees Overseas

A Volunteer or trainee found to be involved with drugs in a manner not authorized for medical purposes, in any way in any country, will be administratively separated immediately. The Peace Corps enforces this strict policy not only because the cultivation, manufacturing, and trafficking, and use of drugs, including marijuana, is illegal in most countries, but also because drug involvement by Volunteers in any country could seriously jeopardize an entire Peace Corps country program, as well as the safety and health of other Volunteers and trainees.

The Peace Corps leaves decisions regarding the use of alcohol to the discretion of the individual Volunteer. The Peace Corps recognizes, however, that excessive use of alcohol may compromise Volunteer safety and security, lead to behavior that discredits the Peace Corps or the individual Volunteer, or affect the Volunteer’s performance and success in an assignment. Examples of such behavior include, but are not limited to: public intoxication, drinking while at a work site, failure to appear for work or training due to intoxication or hangovers, and verbal or physical aggressiveness while under the influence of alcohol. Such inappropriate or unsafe behavior or inability to perform adequately in the assignment may be grounds for disciplinary action, including administrative separation.

I confirm that I have read the Peace Corps Drug and Alcohol Policy.

Intelligence Background

The Peace Corps has a longstanding policy excluding individuals who have engaged in intelligence activity or related work or who have been employed by or connected with an intelligence agency from Peace Corps Volunteer service, either for a specific period of time or permanently, depending on the agency. For more information, including definitions of “intelligence activity” and “intelligence agency,” visit peacecorps.gov/legalinfo. 

If you are a current or former employee of the Central Intelligence Agency (CIA), you are permanently ineligible for Peace Corps Volunteer service. If you are currently or were formerly employed by another intelligence agency, you are ineligible for Peace Corps Volunteer service for at least 10 years from the end date of such employment. In addition, you may be disqualified for service because your background or history discloses a substantial connection with an intelligence activity or related work other than through employment. Even family relationships to an employee of an intelligence agency may be considered a disqualifying connection. The duration of the disqualification will ordinarily not exceed 10 years and will depend on the nature of your involvement in or relationship to intelligence activities or agencies. 

You should also be aware that, if you serve as a Peace Corps Volunteer, you may be ineligible for employment with U.S. government intelligence agencies for a specified period following your service as a Volunteer.

If you or a family member works for or has worked for the CIA or the National Security Agency, go to peacecorps.gov/legalinfo for further instructions before answering the question below. 

In all other cases, if you indicate that either you or a family member has been employed by or connected with an intelligence agency, or engaged in intelligence activity or related work, a Peace Corps representative will contact you after your application is submitted to obtain additional information and determine your eligibility for Peace Corps Volunteer service.

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

• Yes²⁰

• No

Education

*What is the highest level of education you have achieved, or if currently enrolled, what is the highest level of education you will have received by your date of availability for Peace Corps service? If you are applying as a senior in college and will complete your degree prior to Peace Corps service, choose “College graduate” from the list below. ²¹

Please provide the information listed below for all education institutions you attended, starting with the most recent school. If you don’t see your major on the list, please choose the one that most closely reflects your area of study. If you have not taken higher education coursework, please select “N/A” from the list of schools below.

*School name (schools listed by official name) ²²

If school not listed, provide name:

Major

Second Major

Minor

GPA

Type of degree:

Date degree received or expected (mm/yyyy)

*Did you attend any additional schools? ²³

• Yes

• No

Master’s International

The Master’s International program was retired in 2016. This program offered the opportunity to combine Peace Corps service with a master's degree program. Accepted Master’s International students who began their graduate programs during or before the fall 2016 semester may still apply as Master’s International candidates.

• * Have you been accepted to a Master’s International Program? Yes

• No

Master’s International Information²⁴

*Please select the school and master’s program to which you have been accepted.

*What is the degree you are seeking through the Master's International program?

Peace Corps Prep

Peace Corps Prep is a program that trains undergraduate students for Peace Corps service through a curriculum of coursework, hands-on experience, and professional development activities. Peace Corps Prep is only available to students at participating colleges and universities.

*Will you have received a Peace Corps Prep certificate prior to beginning your Peace Corps service?

• Yes

• No

Peace Corps Prep Information²⁵

*Please select the Peace Corps Prep school from the list: ²⁶

Peace Corps Prep programs often use a checklist to help students capture their programmatic accomplishments and verify that they have met all requirements. If you have a Peace Corps Prep checklist, you may upload it in the applicant portal, which you can access after submitting your application.

Foreign Language Skills

In the countries where the Peace Corps serves, many languages are spoken, including French and Spanish. To be considered for a French- or Spanish-speaking country, prior experience with that language is required.

Please list any languages with which you have experience, beginning with the language(s) that are most relevant for the position for which you are applying. If you do not see the language(s) you speak in the list provided, please select the “other” option at the bottom of the list and write in the language.

If you have selected college course work from the list provided, please upload your transcript (official or unofficial) in the application portal after submitting your application.

Language:²⁷

Please provide the name of the language:²⁸

In order to assess your language skills, please review the list below and check all that apply.

□ Native/bilingual speaker

□ Completed college-level Intermediate II (e.g., SPAN 202) in the past 6 years

□ Score of 4 or better on the high school Advanced Placement exam in the past 8 years

□ Score of 5 on the high school International Baccalaureate Assessment in the past 8 years

□ Completed college-level Elementary II (e.g., FREN 102) in the past 6 years

□ Completed 4 years of high school coursework in the past 8 years

□ Proficiency as demonstrated by a score of 50 or greater on the College Level Examination Program exam in the past 6 years

□ Score of Novice-High or greater on official American Council on the Teaching of Foreign Languages Oral Proficiency Interview in the past 6 years.

□ Other

If you selected “Other” in the list above, please briefly describe your experience with this language, including the dates and/or scores of any language courses or language proficiency exams you have taken.

*Do you have an additional language?²⁹

• Yes

• No

Motivation Statement

*Peace Corps service presents major physical, emotional, and intellectual challenges. In the space below, please provide a few paragraphs explaining your reasons for wanting to serve as a Peace Corps Volunteer and how you plan to overcome the various challenges associated with Peace Corps service. This essay is the writing sample Peace Corps uses to assess your professionalism and maturity as a candidate. Please spend time editing your essay/writing sample (up to 500 words).

References

In order to learn more about your success in previous experiences, the Peace Corps requests two references.  If you are selected for an interview with the Peace Corps, we will contact your references at that time.

• If you have held two or more jobs over the past 10 years, one reference must be one of your two most recent job supervisors, and one must be a close friend, professor, or volunteer supervisor.

• If you have had only one job supervisor in the past 10 years, and that individual is your current supervisor, you may elect to include that person as a reference or you may provide two references from close friends, professors, or volunteer supervisor references.

• If you have not had a supervisor, formal employment, or held two or more jobs over the past 10 years, both references must be close friends, professors, and/or volunteer supervisors.

Reference 1

*Reference type³⁰

*Reference Name (first and last name)

*Email address

*Reference telephone

Reference 2

*Reference type³¹

*Reference Name (first and last name)

*Email address

*Reference telephone

Request for Racial and Ethnic Data

This information is voluntary. Your response will not affect consideration of your application. By providing this information, you will assist in assuring that the Peace Corps is administered in a nondiscriminatory manner and reflects the diversity of the United States.

Ethnicity

*Are You Hispanic or Latino? (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)

• Yes

• No

• I prefer not to respond

Race

*Please check one or more of the classifications 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 America), 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.

• Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

• I prefer not to respond.

Certification

I certify that all of the statements made 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 service. Any intended omission or intentionally false statement may constitute a violation of federal and state laws and subject you to severe civil and criminal penalties, including fines and/or imprisonment pursuant to 18 U.S.C. 1001. 

I also understand it is my responsibility throughout the application process, up through the start of service, to inform the Peace Corps promptly of any changes to the information provided here. Failure to do so may be cause for disqualification or termination of Peace Corps service.

*Signature

*Date: MON-DD-YYYY

Review

Each section of the application is available for review and edits.

1 This question appears if applicant responds “No” to preceding question.

2 A “No” response redirects the applicant out of the application: Thank you for your interest in the Peace Corps. The information you entered suggests you may not meet our eligibility requirements at this time.

3 A “No” response redirects the applicant out of the application: Thank you for your interest in the Peace Corps. The information you entered suggests you may not meet our eligibility requirements at this time.

4 “Other name” and “Dates used” appears only if applicant responds “Yes” to preceding question.

5 Applicant can list up to four total other names and dates used.

6 This question appears if applicant responds “Yes” to preceding question.

7 This section appears if applicant responds “Yes” to preceding question.

8 This section appears if applicant responds “Yes” to preceding question.

9 This section appears if applicant responds “Yes, I am planning to serve with my domestic partner.”

10 Applicant selects one to describe living arrangement.

11 Text area provided for explanation.

12 This section appears if applicant answers “Yes” to preceding question.

13 Applicant can list additional dependents.

14 This question appears if applicant responds “Yes” to preceding question.

15 Section appears if applicant answers “Yes” to preceding question.

16 Section appears if applicant answers “Yes” to preceding question.

17 Applicant chooses from the following: guilty (including expunged/sealed), dismissed, diversion program, not guilty, deferred judgments/suspended sentence, or other.

18 Section appears if applicant answers “Yes” to preceding question.

19 Applicants can report up to five legal incidents on the Peace Corps application. After five legal incidents, the following instructions and question appear: “If there are additional legal incidents in your history, please check the box below. The Legal Eligibility Specialist may contact you for further details.”

20 If applicant selects “Yes” a Peace Corps staff member will contact the applicant for details.

21 Applicant selects one of the following from dropdown menu: Graduate degree, Graduate study, College graduate, Incomplete college study, A.A. degree or equivalent, Technical school graduate, High school graduate/GED, Did not complete high school.

22 Applicant selects a school from dropdown menu.

23 Applicant can list up to three education institutions.

24 Section appears if applicant answers “Yes” to preceding question.

25 Section appears if applicant answers “Yes” to preceding question.

26 Applicant selects program from dropdown menu.

27 Applicant selects language from dropdown menu.

28 If applicant selects “Other” from the language drop down menu, a text box will appear.

29 Applicant can list up to three languages.

30 Applicant selects one of the following from dropdown menu: Job Supervisor, Volunteer Supervisor, Close Friend, Professor

31 Applicant selects one of the following from dropdown menu: Job Supervisor, Volunteer Supervisor, Close Friend, Professor

This is a copy of the application for reference purposes only. This document is not to be used to apply to the Peace Corps. Notes in green are informational and not part of the actual online application. Questions with a red asterisk require a response from the applicant.