Form 1 Employers of National Service Enrollment Form

Instructions:
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We encourage you to first review all the items before you begin entering information. Unfortunately, you
cannot save and return to this form.

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Please note that items marked with an asterisk (*) are required.

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If you have feedback to share about this form, please do so in the comments box at the end of this form.

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

You will receive confirmation of your submission within five business days. Thank you!
NOTE: This is not an application to have AmeriCorps members serve at your organization. To learn more
about AmeriCorps grants, please visit nationalservice.gov.
1. Employer Name *

2. Employer Description *

3. Employer Type *
Private Sector
Nonprofit Organization
Institution of Higher Education
School/School District
State or Local Government
Federal Government
Other
If "other," please describe:

4. Employer Location
Street Address *
Street Address (Line 2)

City *

State *

Zip Code *

Additional Location(s)

5. Workforce Information
Below, please include permanent full- and part-time staff only, including paid fellows or apprentices. Exclude
seasonal staff, student employees, interns, volunteers, and national service participants (ie, AmeriCorps members).
Current number of employees at your organization *
Number of employees hired in the previous calendar year
Current number of AmeriCorps, Peace Corps, or other national service alumni on staff
6. What is your organization committing to do as an Employer of National Service? Please check all that apply. *
Note: Organizations that are Employers of National Service will be asked to report annually about the number of
applications, interviews, and hires who have served in AmeriCorps or Peace Corps.
In job postings, included language encouraging AmeriCorps, Peace Corps, and national service alumni to apply
On job applications, incorporated a check box for AmeriCorps, Peace Corps, and national service alumni
Provided special hiring consideration for AmeriCorps, Peace Corps, and national service alumni
Provided interviews for qualified AmeriCorps, Peace Corps, and national service alumni
Created positions exclusively for AmeriCorps, Peace Corps, and national service alumni
On website, included language identifying your organization as an Employer of National Service
Maintained a relationship with an AmeriCorps, Peace Corps or national service program as a service to
employment pipeline
Other (describe below)
If you are interested in ONLY implementing an action different from the options listed above, please describe your
proposal below. A representative of CNCS or a partner organization will contact you to discuss your proposal
further or with final approval.

7. Contact Information for Programmatic Coordinator
Typically involved in human resources, this person will be directly involved in implementing Employers of National
Service at your organization.
Name *

Title *

Phone (xxx-xxx-xxxx format) *

Email *
8. Contact Information for Partnerships Coordinator
Please indicate the person who leads your organization's partnership-related efforts.
Name *

Title *

Phone *

Email *

9. Contact Information for Media Coordinator
We may contact your media coordinator ahead of large events or for press outreach relating to Employers of
National Service.
Name *

Title *

Phone *

Email *

10. Organization Career Page *
11. Quote (Optional). Statement from the head of your organization (or another senior leader) about Employers of
National Service. Please include why you believe that AmeriCorps and Peace Corps alumni have important skills
and make good employees.

12. How did you hear about Employers of National Service? *
AmeriCorps Alums
Corporation for National and Community Service
National Peace Corps Association
Peace Corps
The Service Year Alliance
Other
Please specify the source of information: *
Optional Comments