Form 0420-0533 PC Repsonse Application

Apply Now to Peace Corps Response
* indicates a required field.

Contact Information
* First Name
* Last Name
* Street address
* City
* State
* Zip code
Day phone
ext.
Evening phone
ext.
Fax
* E-mail address
* Country of service
* From (yyyy)
* To (yyyy)
Second country (if applicable)
From (yyyy)
To (yyyy)

Describe your Peace Corps Volunteer Assignment (e.g. Education — taught secondary school science; Water and
Sanitation — built latrines)

2000

characters remaining

* Upload your resume Word DOC, PDF, TXT, and RTF formats are accepted

Language Skills
Specify each language with level of spoken skill: fluent, conversational, basic.
1.
2.
3.
4.
Degrees, Professional Licenses, and Certifications(please specify)

Technical Skills
Please check only those skills in which you have at least one year's work experience.



Administration/Management



Agriculture



Agroforestry



Business/Economic Development



Construction



Education



Environment



Health



HIV/AIDS Activities



Mental Health



Organizational/NGO Development



Water and Sanitation



Youth Development



Other

Additional Overseas Work Experience
Please check those regions in which you have at least one year's work experience.



Africa



Asia



Caribbean



Europe



Inter-America



Mediterranean



Pacific

Availability for Peace Corps Response Assignments
* Length of service

* Availability



Available throughout the year



Available part of the year



From: (mmyy)

to: (mmyy)

Which open positions other than Art Teacher do you wish to be considered for? (You may select up to three). To
select multiple positions, hold down the CONTROL key and click on all positions of interest.
Advisor on Environmental Education for Sustainable Development (Georgia)
Agribusiness Specialists (Madagascar)
Agro-business Initiative Coordinators (Panama)
Agroforestry Technician (Guinea)
Aquaculture Stakeholder Organizer (Mozambique)
Arts Curriculum Development Specialist (Benin)
Associate Professor of Chemistry (Malaw i)
Business Development Trainer (Saint Kitts and Nevis)
Business/NGO Development Advisor (Suriname)
Capacity Building Specialist (Suriname)
Civil Engineer (Guyana)
Community Livelihood Consultant (Philippines)

How did you learn about Peace Corps Response?


COS conference



website



Hotline



Peace Corps mailing



Other
Submit

OMB Approval Number 0420-0533
Expiration Date: 11.30.2010
Privacy Act Notice: Authority to request this information is the Peace Corps Act {22 U.S.C. §2501 et seq.} (as
amended). This information will be used to help determine suitability as for the Peace Corps Response. This
information may be used for the routine uses described in the Privacy Act, 5 U.S.C. 552a, and Peace Corps'
published Routine Uses, summarized in Peace Corps' System of Records. Disclosure of this information is voluntary.
Failure to provide sufficient information may preclude your consideration for Peace Corps Response.
The Peace Corps Act (22 USC 2501 et seq.) authorizes this collection of information for the recruitment of persons
for service in Peace Corps Response programs. Providing the information herein requested is voluntary. This
information will only be used to determine your interest in Peace Corps Response service, and it will remain entirely
confidential. Estimated completion time: 5 minutes. OMB control number 0420-0533. The Peace Corps 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.