Form DI-4014 United States Youth Conservation Corps - Crew Member App

Form DI-4014 (Rev. 07/2020) OMB Control No. 1093-####

U.S. Department of the Interior Expires ##/##/####

UNITED STATES YOUTH CONSERVATION CORPS

CREW MEMBER APPLICATION

PROGRAM OVERVIEW

The United States Youth Conservation Corps (YCC) is a summer youth employment program that engages young people in meaningful work experiences on national parks, forests, wildlife refuges, and fish hatcheries while developing an ethic of environmental stewardship and civic responsibility. YCC members work on projects that promote awareness and appreciation of the public lands legacy and the nation’s natural, cultural, and historic resources.

The YCC is administered jointly by the U.S. Department of the Interior – National Park Service and Fish and Wildlife Service, and the U.S. Department of Agriculture – Forest Service.

ELIGIBILITY REQUIREMENTS

Applicants must:

• Be at least 15 years of age at the start of enrollment and must not reach age 19 before completion of the program

• Be a US citizen or permanent resident of the United States, its territories, or its possessions

• Provide or be able to obtain a work permit as required under the laws of the applicant’s home state

• Provide a valid U.S. Social Security number or have applied for a valid Social Security number

• Be able to fulfill the essential functions of the assigned work with or without a reasonable accommodation

• Be actively committed and willing to complete the assigned work project

PROGRAM BENEFITS

The YCC affords members a variety of opportunities to work on projects such as constructing and repairing trails, preserving and repairing historic buildings, removing invasive species, assisting with wildlife and land research, leading environmental education programs, and supporting agency staff.

HOW TO APPLY

For more information on how to apply to YCC programs and opportunities, please visit agency webpages for locations, application process and due dates, and points of contact. Eligible applicants should follow the instructions for completing and submitting the application as directed by YCC program sites. Applicants may also contact the neared YCC program office managed by the National Park Service, U.S. Fish and Wildlife Service or U.S. Forest Service for more information.

Please visit the following sites For YCC opportunities

• National Park Service,: https://www.nps.gov/subjects/youthprograms/ycc.htm

• U.S. Fish & Wildlife Service, please visit: https://www.fws.gov/refuge/seney/jobs/ycc.html

• U.S. Forest Service, please visit: http://www.fs.fed.us/working-with-us/opportunities-for- young-people/youthconservation-corps-opportunities

Please fill out this application as thoroughly and legibly as possible. Mail the completed application to the Youth Conservation Corps (YCC) Program site location where you would like to work using the YCC mail address (or email if acceptable) listed on the Federal agency’s website.

This application must be filled out completely to determine the applicant’s eligibility and availability. Incomplete applications will be rejected. Complete applications include responses to all questions, parent/guardian contact information and certification signatures. An optional resume may also be submitted with the application but is not required.

Name:

First: ________________________

Middle _____________________

Last ______________________

Suffix ________

Gender:

 Male

 Female

 Prefer not to disclose

Date of Birth:

mm/dd/yyyy ____/_____/______

Age_______

Tell Us About Yourself

Please answer the following questions regarding your background, contact and other information.

Contact Information

Address:

Street: ____________________________________________

City: ____________________

State _________ Zip ______

Emajl: ____________________________________________

Phone 1: ________________

Phone 2: ___________________

What is the best way and time to contact you?

If under 18, provide parent/guardian contact information:

Emergency Contact Information 1

Emergency Contact Information 2

First Name

Last Name

First Name

Last Name

Relationship to Applicant

Relationship to Applicant

Phone 1

Phone 1

Phone 2

Phone 2

Email

Email

How did you learn about the YCC program? (Select all that apply)

 Website	 Past/Current YCC
 School Counselor	 Poster
 National Park Service, U.S. Fish & Wildlife Service, Or U.S. Forest Service Staff Member	 Other

OTHER INFORMATION

1. Are you able to perform work that could be physically strenuous and in adverse weather conditions such as rain or heat?  Yes  No

2. Will you require accommodations to perform work that may be assigned to you?  Yes  No

If you answer yes to either question #1 and #2, tell us what types of work you are unable to perform and/or describe the types of accommodations you may need to work in the outdoors or otherwise.

Tell us why you want to join the YCC.

You are encouraged to use the space below to complete the following essay question or attach a new page for your entire response.

In 200 words or less, please explain why you want to serve as a YCC Crew Member.

5. CERTIFY YOUR APPLICATION

I am familiar with the Youth Conservation Corps (YCC) Program and am interested in working to develop and maintain the natural and cultural resources of the United States.

I certify that I understand the work and environmental conditions that might exist while serving as a YCC member. I understand that I may be exposed to physical work, insects, poison oak and ivy, adverse weather, and outdoor working conditions up to eight hours a day during service.

I certify that I meet all YCC program eligibility requirements. I am a citizen or permanent resident of the United States or its territories or its possessions. I have or am applying for a valid U.S. Social Security number. I will be at least 15 years of age by the beginning of enrollment and will not reach age 19 before completion of the program. And finally, if selected, I will obtain a work permit, if required.

I certify that all information I have provided on this application is true and correct to the best of my knowledge.

I understand that incorrect statements constitute grounds for immediate dismissal. With my signature, I certify that I give my permission for this form to be reviewed by any YCC official.

Applicant Name Applicant Signature Date

For applicants under the age of 18:

By signing this document, I, the parent/legal guardian of the above applicant, acknowledge that I have discussed the YCC program with the applicant. I give permission for the applicant to apply for and participate in, the YCC program, if chosen.

Parent/Legal Guardian Name Parent/Legal Guardian Signature Date

References

Please list two references not related to you, with full name, address, phone number, and relationship

Reference 1			Reference 2
First Name		Last Name	First Name		Last Name
Relationship to Applicant			Relationship to Applicant
Phone			Phone
Reference 2			Reference 2
First Name		Last Name	First Name		Last Name
Relationship to Applicant			Relationship to Applicant
Phone			Phone

NOTICES

PRIVACY ACT STATEMENT

Authority: 16 USC 1701-1706, Chapter 37 – Youth Conservation Corps and Public Lands Corps, Subchapter I – Youth Conservation Corps (Youth Conservation Corps Act of 1970 (P.L. 91-378; 84 Stat. 794) as amended in 1972 (P.L. 92-597) and in 1974 (P.L. 93-408).

Purpose: The information is collected to evaluate the eligibility of youths aged 15-18 years of age for employment with the Youth Conservation Corps (YCC).

Routine Uses: The information collected on this form may be shared in accordance with the Privacy Act of 1974 and the routine uses listed in the DOI Office of the Secretary (OS) System of Records Notices INTERIOR/OS-25, YCC Enrollee Records, and INTERIOR/OS-29, YCC Recruitment Files available at https://www.doi.gov/privacy/os-notices.

Disclosure: Furnishing this information is voluntary; however, failure to provide the requested information may disqualify acceptance into the YCC program.

PAPERWORK REDUCTION ACT STATEMENT

In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Department of the Interior and the U.S. Department of Agriculture – Forest Service, collects information necessary to assist the agencies in safeguarding the health, safety, and welfare of the enrollees of the YCC programs. Your response is voluntary, but failure to complete this form will result in exclusion from participation in the YCC Program. According to the Paperwork Reduction Act of 1995, 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. OMB has approved this collection of information and assigned Control No. 1093-####.

ESTIMATED BURDEN STATEMENT

We estimate public reporting for this collection of information to average 25 minutes, including time for reviewing instructions, gathering and maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of the form to the Departmental Information Clearance Officer, U.S. Department of the Interior, 1849 C Street, NW Washington, DC 20240, or via email at [email protected]. Please do not send your completed form to this address.

V. ADDITIONAL INFORMATION

Please use this page to answer questions or to include more information to submit a complete YCC application.

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