Form PC-2174 Onboarding form

Volunteer Recruitment and Selection Onboarding form

Onboarding_DOVE 2 0 Peace Corps

Volunteer Recruitment and Selection Onboarding form

OMB: 0420-0563

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Onboarding


Getting Started1

This portal is where you will submit important pre-departure information. Please complete the activities in this portal within two weeks of receiving your access email. You will need approximately one hour in total. If you cannot complete everything in one sitting, the system will allow you to proceed where you left off. One month prior to departure you will receive information about your staging event and departure logistics. All activities in this portal must be completed and you must have legal and medical clearance in order to receive your staging information.

The Staging Unit will be your point of contact for questions on this portal, unless an activity or form instructs you otherwise. The Staging Unit can be reached at 855.855.1961, option 1, extension 1865 or [email protected].

To get started, please carefully review and update your permanent address below (this is the permanent address you provided when you accepted your invitation), as some of the information will flow into subsequent activities. Then, click “Submit” to proceed.

*First Name

Middle Name

*Last Name

*Social Security Number

*Date of Birth

*Primary Phone

*Address Line 1

Address Line 2

*City

*Country

*State/Region/Province

*Zip/Postal Code


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 request for information. The Privacy Act addresses the federal government’s use of certain personal information in agency files.

A. This request for information is authorized by the Peace Corps Act (22 U.S.C. 2501 et seq.) as amended.

B. With the exception of the information requested in connection with the Hometown News Press Release, the information you provide will be used to process administrative actions to enable you to serve as a Peace Corps Volunteer. In addition, if you elect to provide the information requested in connection with the Hometown News Press Release, that information will be used to inform your local hometown media that you will be serving in the Peace Corps.

C. The information you provide on this form 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 form is voluntary. However, failure to complete this form may impair the Peace Corps’ ability to process certain administrative actions and may delay or preclude your start of Peace Corps service.

Paperwork Reduction Act 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.

OMB Control No. 0420-xxxx

Expiration Date 08-31-2021

Emergency Contact Information2

The information that you provide in this activity will inform the Peace Corps of whom to contact in the case of an emergency.

First, please provide a “Designated Representative/Next of Kin3” contact. This can be a family member or a designated representative. The Peace Corps will notify this person in the event that you die, are incapacitated, or are otherwise unable to make decisions for yourself. In those circumstances, this person will be authorized to make decisions and otherwise act on your behalf. You must name one (and only one) person to be your designated representative/next of kin.

Next, please provide emergency contacts. These are individuals the Peace Corps may choose to notify in the event of other emergencies. If you wish, you may re-enter your “Designated Representative/Next of Kin” contact as an emergency contact.

*Designated Representative/Next of Kin First Name

Designated Representative/Next of Kin Middle Name

* Designated Representative/Next of Kin Last Name

* Designated Representative/Next of Kin Relationship

* Designated Representative/Next of Kin Address

* Designated Representative/Next of Kin Country (Dropdown)

* Designated Representative/Next of Kin State

* Designated Representative/Next of Kin City

* Designated Representative/Next of Kin Zip/Postal Code

* Designated Representative/Next of Kin Phone

Designated Representative/Next of Kin Phone (Alternate)

Designated Representative/Next of Kin Phone (Work)

Designated Representative/Next of Kin Email


*1st Emergency Contact First Name

1st Emergency Contact Middle Name

*1st Emergency Contact Last Name

*1st Emergency Contact Relationship

* 1st Emergency Contact Country (Dropdown)

*1st Emergency Contact Address

*1st Emergency Contact City

*1st Emergency Contact State

*1st Emergency Contact Zip/Postal Code

*1st Emergency Contact Phone

1st Emergency Contact Email


*2nd Emergency Contact First Name

2nd Emergency Contact Middle Name

*2nd Emergency Contact Last Name

*2nd Emergency Contact Relationship

*2nd Emergency Contact Country (Dropdown)

*2nd Emergency Contact Address

*2nd Emergency Contact City

*2nd Emergency Contact State

*2nd Emergency Contact Zip/Postal Code

*2nd Emergency Contact Phone

2nd Emergency Contact Email


Post (Autofill)

I understand that (a) disclosures made by the Peace Corps to the persons I have listed in this form may include medical information which the recipient might then disclose to other persons and (b) the authorizations I have made in this form will remain in effect until the close of my Peace Corps service. However, I may change or withdraw the authorizations in writing at any time.

Eligibility Verification4

You previously shared your legal history during your application and interview. This activity is intended to capture any updates to your legal history.

For any “Yes” responses, the eligibility specialist in the Office of Placement will contact you for more information, as it is essential that any “Yes” responses be discussed in advance of your start of service. Failure to communicate with the Office of Placement may be cause for withdrawal of your invitation to enter training or for termination of your Peace Corps service. If you have any questions regarding this activity, please contact [email protected].

Since the time of your Peace Corps interview:

(Select No/Yes from dropdown for each question.)

*Has the status of your citizenship changed?

*Has your marital status changed?

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

*Have you been employed by, filed an employment application with, or in any way been associated with intelligence activities of any agency of the U.S. government or any other government? (Intelligence activity is defined as the clandestine collection, dissemination, or analysis of information intended for use by any government in formulating or implementing political or military policy in regard to other countries, and/or covert activities of any kind designed to influence events in foreign countries.)

*Have you been convicted of any offense by a civilian or military court?

* Have you been subjected to any disciplinary action by a military court or tribunal?

* Have you been arrested for, charged with, or cited for any offense (exclude parking tickets and traffic fines less than $300.00)?

* Have you filed any civil suits or have any civil suits been filed against you?

* Have you been notified that your presence or testimony is requested in any civil or criminal action?

* Do you have any legal obligations that cannot be satisfied prior to Peace Corps service?

* Have you been placed on any court-ordered probation or parole?

Comments: (Text box)

First Name (Autofill)

Last Name (Autofill)

Post (Autofill)

Direct Deposit5

This activity establishes a direct deposit pay method for your readjustment allowance and any applicable travel payments made near the conclusion of your service. The readjustment allowance is a payment authorized by the Peace Corps Act to assist returned Peace Corps Volunteers in transitioning from Peace Corps service to other endeavors.

The Peace Corps only makes direct deposits to valid U.S. dollar checking or savings accounts and does not make wire transfers. Please provide your banking information to set up the direct deposit.



If you have any questions regarding this activity, please contact 202.692.1770 or [email protected].


  • * All Peace Corps Volunteers must enroll in direct deposit. By enrolling in direct deposit you are authorizing the Peace Corps to deposit your readjustment allowance directly into the account as indicated. 


*Bank Name

*Bank Routing Number6

*Bank Account Number

*Type of Account (Checking or Savings)

Authorization to Release Financial Information7

In accordance with the Privacy Act, 5 U.S.C. § 552a, Peace Corps personnel, under most circumstances, may not release to third parties any information in a system of records regarding U.S. citizens without the express written consent of the concerned citizen(s). 


This activity allows you to identify a financial contact to whom the Peace Corps may release a copy of your W-2 for the purpose of completing your tax return. It also allows the Peace Corps to release information regarding your student loans if your financial contact is making payments on your behalf.

Option 1:  I do not authorize the Peace Corps to release to third parties any financial information within a Peace Corps system of records kept under my name and/or Social Security number.


Option 2: I authorize the Peace Corps to disclose to the person identified below all matters concerning any financial information within a Peace Corps system of records kept under my name and/or Social Security number. This authorization includes, but is not limited to, release of my W-2 and disclosure of information relating to my student loans. I understand that signing this form will not result in the Peace Corps automatically releasing anything other than a duplicate copy of my W-2 to the person identified below. The person identified below must contact the Peace Corps to request any additional financial information.


*Please select Option 1 or 2. (Dropdown)


Financial Contact First Name

Financial Contact Middle Name

Financial Contact Last Name

Financial Contact Address (Number and Street)

Financial Contact Country (Dropdown)

Financial Contact City

Financial Contact State (Dropdown)

Financial Contact Zip/Postal Code

Certification of Peace Corps Service8

Prior to departure, Invitees at times need confirmation of their Peace Corps status to share with a third party, such as a cell phone company, gym, or landlord. This activity provides you with a certification of Peace Corps service to use for such purposes. To generate a certification of service letter, please select “Yes” below. The letter will populate only after you have completed all other onboarding activities.

*Would you like to receive a certification of Peace Corps service letter?

  • Yes

  • No

Student Loan Information9

This activity provides information regarding student loan options during Peace Corps service, as well as a certification of your Peace Corps status that you can provide to lenders. To generate a certification of service letter, please select “Yes” at the bottom of this activity. The letter will populate only after you have completed all other onboarding activities.

Volunteers have several options for managing student loans. We encourage prospective Volunteers with student loan debt to review every option available and to speak with their lenders about what is best. To learn more, please review the following:

Peace Corps: Student Loan Information

Department of Education: Peace Corps and Repayment of Your Federal Students Loans

Consumer Financial Protection Bureau: Guide for Peace Corps Volunteers with Student Debt

Peace Corps Volunteer Perspective:
10 Things You Need to Know About Peace Corps and Student Loans

Specific Options:

  1. Income-Driven Repayment Plan.

  2. Public Service Loan Forgiveness (PSLF): The Peace Corps can assist you with this program by certifying in Section 4 of the PSLF Employment Certification form if you bring it to your staging. If you have questions about how to complete the PSLF form, please click here.

  3. Deferment: This is a temporary postponement of student loan payments for reasons such as economic hardship, period of unemployment, or at least half-time enrollment in a college or a career school. Deferment typically needs to be renewed on a yearly basis. Interest on the loan may continue to accrue depending on the type of loan.

If you have any student loan questions, please contact [email protected].

*Would you like to receive a certification of Peace Corps service letter for student loan paperwork?

  • Yes

  • No

Savings Bond Information10

At the end of your service you will receive a readjustment allowance. As of October 2016, the readjustment allowance for a volunteer’s first full tour of service is $35011. Peace Corps Volunteers are not entitled to receive this allowance until completion of service, save for the following exceptions. Peace Corps Volunteers can use the accruing readjustment allowance to purchase savings bonds and to allot payments on financial obligations incurred prior to Peace Corps training or service. The sum of allotments, including a savings bond deduction, cannot exceed 75 percent of the monthly readjustment allowance.

This activity allows you to request a savings bond deduction from your readjustment allowance. If you have any questions regarding this activity, please contact 202.692.1770 or [email protected].

In order to request a deduction from your readjustment allowance to purchase savings bonds, you must have already created an account through TreasuryDirect. Please see the TreasuryDirect website for information on setting up an account: savingsbonds.gov/indiv/indiv_open.htm.


*Do you choose to request a savings bond deduction from your readjustment allowance? If yes, please fill out the information listed below. If no, please click “Submit” to continue.

  • Yes

  • No


In order to request a savings bond deduction from your readjustment allowance, you must have already created an account through TreasuryDirect. Have you created an account?12

  • Yes

  • No


Amount of Monthly Deduction (Maximum of $150)
Treasury Direct Account Number
(Text box)


  • By checking this box, you acknowledge that you are requesting a monthly deduction from your readjustment allowance to be sent to a third party. You are responsible for verifying that payments have been received and that bonds are being purchased through your TreasuryDirect account.

Debt Payment Options 13

At the end of your service you will receive a readjustment allowance. Peace Corps Volunteers are not entitled to receive this allowance until completion of service, save for the following exceptions. Peace Corps Volunteers can use the accruing readjustment allowance to purchase savings bonds and to allot payments on financial obligations incurred prior to Peace Corps training or service.

This activity allows you to request that certain recurring expenses be paid monthly from your readjustment allowance account during service. These payments or allotments are designed to continue payments on obligations incurred prior to Peace Corps service, such as student loans, credit card obligations, or medical expenses. Unexpected emergency expenses, such as family support, may also be paid by monthly allotment. Allotment payments will not begin until you are sworn in as a Volunteer. Payments are made only at the beginning of each month.14

An allotment must be for a minimum of five consecutive monthly payments of at least $25.00 each. Each Volunteer is allowed a maximum of three concurrent allotments (including savings bonds). The sum of allotments, including a savings bond deduction, cannot exceed 75 percent of the monthly readjustment allowance. An allotment must be paid to a third party and cannot be paid to the Volunteer or a family member.

If you have any questions regarding this activity, please contact 202.692.1770 or [email protected].

* Would you like to allot your readjustment allowance?

  • Yes

  • No


Detailed Explanation of Request (Text Area)


Allotment Type One15


Allotment 1: Amount of Monthly Payment (Minimum allotment is $25.00. Total maximum allotment is 75% of monthly readjustment allowance)


Allotment 1: Number of Payments (At least 516. If allotment is to run indefinitely or until the end of your service, enter 99.)


Allotment 1: First Allotment Payment Due (mm/dd/yyyy)


Payee 1 -- Process By:17 (Check)


Payee 1: Name


Payee 1: Address


Payee 1: City


Payee 1: State


Payee 1: Zip


Payee 1: Acct/Policy Number


Allotment Type Two


Allotment 2: Amount of Monthly Payment (Minimum allotment is $25.00. Total maximum allotment is 75% of monthly readjustment allowance)


Allotment 2: Number of Payments (At least 5. If allotment is to run indefinitely or until the end of your service, enter 99.)


Allotment 2: First Allotment Payment Due (mm/dd/yyyy)


Payee 2 -- Process By: (Check)


Payee 2: Name


Payee 2: Address


Payee 2: City


Payee 2: State


Payee 2: Zip


Payee 2: Acct/Policy Number


Allotment Type Three


Allotment 3: Amount of Monthly Payment (Minimum allotment is $25.00. Total maximum allotment is 75% of monthly readjustment allowance)


Allotment 3: Number of Payments (At least 5. If allotment is to run indefinitely or until the end of your service, enter 99.)


Allotment 3: First Allotment Payment Due (mm/dd/yyyy)


Payee 3 -- Process By: (Check)


Payee 3: Name


Payee 3: Address


Payee 3: City


Payee 3: State


Payee 3: Zip


Payee 3: Acct/Policy Number


Authorization to Use Personal Information and Media18

The Authorization to Use Personal Information and Media (the “Authorization”) set forth below allows the Peace Corps to use your name, likeness, and personal media (photos, videos, etc.) for purposes authorized under the Peace Corps Act. This means posting photos and videos of you on the Peace Corps website and social media channels, in Peace Corps’ print and electronic publications, using your name in press releases, etc. You are not required to agree to this Authorization. Your status as a trainee or Volunteer is not affected in any way if you choose not to agree to the Authorization set forth below.

I grant the Peace Corps a world-wide, royalty-free, nonexclusive, license to use, reproduce, distribute, display, perform, prepare derivative works of, and publish my personal information (name and image) and personal media (photos, videos, etc.) for purposes authorized by the Peace Corps Act. I also acknowledge that the Peace Corps may choose not to use my Personal Information and Personal Media at this time, but may do so at the agency’s discretion at a later date. I affirm I own or have the necessary licenses, rights, consents, and permissions for the personal media I have submitted. I acknowledge that I will receive no compensation from the Peace Corps in consideration of this Authorization or the use of the above-listed items pursuant to this Authorization. I understand that agreeing to the terms of this Authorization serves as my legally valid signature and has the full force and effect of a hand written signature.

If you have questions, please contact [email protected].

* Do you agree to the terms of this Authorization?

  • Yes

  • No

Hometown News Press Release19

This information may be used to inform your local hometown media that you will be serving in the Peace Corps. Completing the form is optional, but we encourage you to answer each question thoroughly so we can share accurate information with the media. Please list your hometown newspapers (or other local publications in any format) that you would like us to share your story with. Don’t forget about your college or university publications!

In addition to the publications you list, the Peace Corps may release and publish the information contained in this form to any publication it deems appropriate or on Peace Corps social media channels. If you choose to submit this form, please also agree to the “Authorization to Use Personal Information and Media” activity.

Please note: You will not be able to modify this form once it is submitted. With that in mind, we strongly encourage you to thoughtfully respond to the questions below and review your final answers before submitting.

If you have questions, please contact [email protected].

Privacy Act Notice: This notice is provided under the Privacy Act of 1974, as amended (5 u.s.c. §552a). The information requested is collected under the authority of the Peace Corps Act, 22 u.s.c. §2501 et seq., for the purposes of preparing news reports and other public information for the Peace Corps. This information may also be used for the routine uses described in the Privacy Act, 5 u.s.c. §552a, and in the Federal Register at 65 Fed. Reg. 53,722 (September 5, 2000) and 50 Fed. Reg. 1950, 1962 (January 14, 1985) regarding Peace Corps systems of records pc-17 (Volunteer Records). Providing the material herein is completely voluntary, but failure to authorize the release of this information will make it impossible to provide press releases and other public information regarding your background before you became a Volunteer and your activities while in service. Your signature hereby authorizes the release and publication of any and all information contained herein unless revoked in writing.

* Do you choose to submit a Hometown News Press Release? If yes, please fill out the information required below. If no, please skip to the bottom of the page, click "No" and "Submit."

  • Yes

  • No


First Name (Autofill)

Middle Name (Autofill)

Last Name (Autofill)

Date of Birth (mm/dd/yyyy) (Autofill)

Primary Email (Autofill)

City (Autofill)

State/Region/Province (Autofill)

Zip/Postal Code (Autofill)

Primary Phone (Autofill)

Hometown City and State

What news outlets should we share your story with? Be sure to include local publications as well as those of any educational institutions from which you graduated.

Parent, guardian, or children’s names. Please specify relationships.

Where do they live?

Please note if you, any of your family members, or someone else you know previously served as a Peace Corps Volunteer.

Are you married?

If you are serving with your spouse or partner, please include his/her name.

Name of Secondary School

Secondary School Graduation Year

Please list noteworthy high school or hometown activities

Undergraduate College or University

Degree Title, Major, and Month and Year of Graduation

Graduate University

Graduate University City and State

Graduate Degree Title, Major, and Month and Year of Graduation

Are you currently or have you participated in any Peace Corps university programs including Peace Corps Campus Ambassadors or Peace Corps Prep?

How did your college/university prepare you or lead you to Peace Corps service?

Please list your previous professional and volunteer experience

Peace Corps Job Title (Autofill)

What motivated or attracted you to join the Peace Corps?

What personal or professional goals do you hope to achieve during your Peace Corps service?

What attracted you to your country of service?

What aspect of your upcoming service are you most excited about?

Would you like us to include any other information?


* Are you ready to submit your Hometown News Press Release? We encourage you to review your responses prior to clicking "Submit." You will not be able to modify them at a later time.

  • Yes

  • No

Third Goal Starts Now20

The Peace Corps has three goals. The first two goals you will focus on during your service, but the Third Goal of the Peace Corps starts now and lasts a lifetime!


How to begin:

  • Plan to share your story through a blog, photos, or videos and consider submitting your work in our annual contests for the best blogs and videos.


There are countless ways to share your Peace Corps experience with Americans and achieve the Third Goal. We look forward to your contributions!

* Do you want to participate in Correspondence Match?

  • Yes

  • No

Equal Employment Opportunity21

The Peace Corps is committed to providing equal opportunity to all employees, Volunteers, and applicants for employment and Volunteer service. Please read our equal opportunity statement: https://www.peacecorps.gov/about/agency-jobs/equal-opportunity/.



* I acknowledge receipt of the Peace Corps’ Equal Opportunity Statement.



Select One (Yes)

Life Insurance Designation or Waiver22

The Peace Corps offers optional life insurance coverage through Metlife. The coverage costs $2.19 per month and provides a $32,500 death benefit. Should you opt for this coverage, the cost would be deducted from your readjustment allowance. Here is the policy.

You may cancel the insurance at any time by preparing a waiver, but if you waive the insurance you cannot subsequently be covered during your current service in the Peace Corps.

If you select Option 2, in order to choose Peace Corps' optional life insurance, you will be asked to list beneficiaries in a subsequent activity. You will be allowed to access that activity after completing all of the initial onboarding activities.

If you have any questions regarding this activity, please contact 202.692.1770 or [email protected].

First Name (Autofill)

Middle Name (Autofill)

Last Name (Autofill)

Option 1: I hereby waive the optional life insurance coverage. Option 2: I desire to subscribe to the optional life insurance coverage and designate the beneficiary/s named below to receive any amount of benefits due under the policy. I understand that I can cancel this coverage at any time.23

* (Select One: Option 1 or Option2)

Life Insurance Designation of Beneficiary Information 24

Name of Volunteer (Autofill)

Country of Service (Autofill)

Birth date (Autofill)

  • I desire to subscribe to the Peace Corps Life Insurance and designate the beneficiary/s named below to receive any amount of benefits due under the policy. I understand that I can cancel this coverage at any time.

Given name, middle initial, and last name of each beneficiary

NOTE: If beneficiary is not a relative, please list an address


Relationship

Percentage to be paid

Beneficiary Type (Primary/Contingent)



















I hereby revoke any previous designations, and I designate the person, people, or entity named in Section II as Beneficiary(ies). I reserve the right to change or revoke this designation at any time.

Signature of Volunteer (Electronic)

Date

Peace Corps Service Certification25

Letter autofills.


Loan Deferment Certification26

Letter autofills.



1 Staff note: Fields autofill from Invitation Decision Form and other DOVE Talent Record fields. These fields inform subsequent Onboarding activities and the export of data upon EOD (Enter on Duty) status applied.

2 Staff note: Designated Representative/Next of Kin data flows into CFO/Odyssey and is shared with OHS/COU via automated weekly Odyssey report. This information does not flow into VIDA. Emergency Contact data flows into VIDA for regional use. OHS/COU also has access to the emergency contact information.

3 Staff note: Only “designated representatives” are authorized under HIPAA to receive medical information about someone after they die. Therefore, this term must be used.

4 “Yes” responses automatically emailed to [email protected].

5 Staff note: This activity is owned by CFO/VPS.

6 If an invalid number is provided the following error message appears: “The Routing Number you have entered is not a valid Routing Number. A valid Routing Number may begin with a zero and is nine (9) digits in length. If you are unsure of the Routing Number you have entered, please contact your financial institution.”

7 Staff note: This activity is owned by CFO/VPS.

8 Staff note: This activity is owned by CFO/VPS.

9 Staff note: This activity is owned by CFO/VPS.

10 Staff note: This activity is owned by CFO/VPS.

11 Readjustment allowance schedule: $25/month increase every other year (October 2016, October 2018, October 20)

12 Staff note: This question serves as a reminder for the Invitee that they must have a TreasuryDirect account established, as the following fields cannot be required.

13 Staff note: This activity is owned by CFO/VPS.

14 Staff note: Once a record becomes PCV in Odyssey, the allotment will trigger in the next monthly accrual payroll which is run on the first of the month. PCT status in Odyssey, even if they have an allotment element, prevents allotment from processing.

15 Choices: Credit Card, Family Support, Loan, Medical, Misc Debt, Other, Student Loans

16 Invitee must choose an integer, not write out the number.

17 Staff note: “Check” is the only option Peace Corps can accommodate.

18 Staff note: This activity is owned by the Office of Communications.

19 All “yes” submissions are emailed to the Office of Communications. Invitees should not be encouraged to go back and edit this form, as the submission is immediately shared.

20 Staff note: This activity is owned by the Office of Third Goal.

21 Staff note: This activity is owned by OCRD.

22 Staff note: This activity is owned by CFO/VPS.

23 Staff note: Unable to space options differently due to html restrictions.

24 Activity only appears if Invitee elected Life Insurance. Invitee can save or print the form for their records.

25 Activity only appears if Invitee elected to get this letter. Invitee can save or print the letter for their records.

26 This activity only appears if the Invitee elected to get this letter. Invitee can save or print the letter for their records.

18


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AuthorQuizon, Carmen
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File Created2021-01-22

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