"Americorps Member Screening/Interview Evaluation Form - Northwest Service Academy"

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Member Screening/Interview Evaluation Form
Applicant ________________________________________
Date: _____________________________
Interviewed by ____________________________________
Time of Interview:___________________
INTERVIEW
 Yes  No Did you receive the pre-interview packet?
 Yes  No Do you have any questions? What position are you interviewing for?__________________________________
 Yes  No Where did you hear about our program? ________________________________________________________
 Yes  No Have you ever been an AmeriCorps member before? Where? ____________________________________
 Yes  No Given your knowledge of the position, are there any tasks that you could not perform?
RATING SCALE
1 = Not a good match
2 = Poor
3 = Average
4 = Good
5 = WOW!
1. _________ Explain why you are interested in being a member of our team?
2. _________ Please share with us how your background has prepared you for this position. Specifically address any skills you have
acquired that are applicable to the following FOUR areas (I can repeat these at any time):
Working in teams:
Working with students (IP); outdoors (FT):
Working with community groups:
Coordinating and/or organizing:
3. _________ We realize our program can be challenging – challenging to different people for different reasons. What challenges do you
think you will face in this position and how will you address them?
4. _________ (Please indicate that this is a situational question)
Field Team. Your team is on a salmon recovery project and is working in groups of three. One member of your group is
sitting on the bank while you and the other team member are hauling logs, shoveling gravel, and standing knee-deep in
cold water. How do you address this situation?
Individual Placement. (Tailor this question based on what position they are interested in) Your placement is in a middle
school. You took this placement because there was a great deal of focus on “at-risk” youth (e.g., working with ESL
students, truancy, and a naturescaping project). For the last two weeks most of your time has been spent on recess duty
and making phone calls and copies for various teachers. How do you address this situation?
5. _________ Name a time when you experienced conflict on a job. Please be specific and tell us how you dealt with it.
6. _________ What does community service mean to you? Please describe your experience working with diverse groups of people.
Contributed by NWSA (Northwest Service Academy, Portland, OR). An EnCorps resource. Please retain the original program attribution when adapting or
using this resource. Rev. June 2007.
Member Screening/Interview Evaluation Form
Applicant ________________________________________
Date: _____________________________
Interviewed by ____________________________________
Time of Interview:___________________
INTERVIEW
 Yes  No Did you receive the pre-interview packet?
 Yes  No Do you have any questions? What position are you interviewing for?__________________________________
 Yes  No Where did you hear about our program? ________________________________________________________
 Yes  No Have you ever been an AmeriCorps member before? Where? ____________________________________
 Yes  No Given your knowledge of the position, are there any tasks that you could not perform?
RATING SCALE
1 = Not a good match
2 = Poor
3 = Average
4 = Good
5 = WOW!
1. _________ Explain why you are interested in being a member of our team?
2. _________ Please share with us how your background has prepared you for this position. Specifically address any skills you have
acquired that are applicable to the following FOUR areas (I can repeat these at any time):
Working in teams:
Working with students (IP); outdoors (FT):
Working with community groups:
Coordinating and/or organizing:
3. _________ We realize our program can be challenging – challenging to different people for different reasons. What challenges do you
think you will face in this position and how will you address them?
4. _________ (Please indicate that this is a situational question)
Field Team. Your team is on a salmon recovery project and is working in groups of three. One member of your group is
sitting on the bank while you and the other team member are hauling logs, shoveling gravel, and standing knee-deep in
cold water. How do you address this situation?
Individual Placement. (Tailor this question based on what position they are interested in) Your placement is in a middle
school. You took this placement because there was a great deal of focus on “at-risk” youth (e.g., working with ESL
students, truancy, and a naturescaping project). For the last two weeks most of your time has been spent on recess duty
and making phone calls and copies for various teachers. How do you address this situation?
5. _________ Name a time when you experienced conflict on a job. Please be specific and tell us how you dealt with it.
6. _________ What does community service mean to you? Please describe your experience working with diverse groups of people.
Contributed by NWSA (Northwest Service Academy, Portland, OR). An EnCorps resource. Please retain the original program attribution when adapting or
using this resource. Rev. June 2007.
Member Screening/Interview Evaluation Form ▪ Page 2 of 2
7. _________ Describe a time when your expectations were not met and how you dealt with it.
8. _________ Overall impression: Is there anything else you would like to share that would help us in making our decision?
Drivers We need to have several drivers per team throughout the service year to break up driver responsibilities. You do not have to be a
driver in order to get a position with our organization, but we would like to determine those who are eligible.
In order to be a driver in our program you must meet the following criteria: 21 years of age; valid driver’s license; clean driving record;
able to produce a driving abstract that will show no more than two moving violations in the past 3 years). You also need to feel
comfortable driving a 15-passenger vehicle and willing to take a defensive drivers training class. Do you qualify?
Yes
No
If yes, you will be notified prior to orientation if you have been selected to be a driver.
Commitment The program commitment is __?_. Since our program is so competitive and there are so many people excited about
positions with us, please consider all of our program expectations before accepting a placement with us, so that you don’t take a
position away from someone else.
TOTAL SCORE ____________
RECOMMENDATION
Field Team Interviews
IP Interviews
Not Good Match
Explanation if necessary:
SCREENING
 Yes  No Is applicant of legal age to participate?
 Yes  No Is applicant a legal, permanent resident?
 Yes  No Is applicant clear of any legal convictions? (If no, please indicate at the end of the form).
_______ Overall Rating based on the following skills: Motivation and Commitment, Flexibility, Maturity, Interpersonal Skills,
Productive Capacity, Related Work/Volunteer Experience
Please list strengths and weaknesses. Note anything that would discourage an interview altogether.
Comments:
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