Please provide full legal name. *

First + Middle, Last + Suffix

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What position are you applying for? *

Internship

AmeriCorps VISTA

Other

Required Background Check * *

You agree to allow Norte Youth Cycling to run a personal background check.

Yes

No

Have you lived outside of northern Michigan in the last three years?* *

Yes

No

Have you ever been convicted of, pled guilty or nolo contendere (neither admitting nor denying the charge) to, or received a suspended imposition of sentence, been placed on probation, or otherwise been found guilty of any criminal or municipal ordinance violation? *

Yes

No

Have there ever been allegations, complaints, or reports regarding your involvement in child abuse or neglect (regardless of whether the incident was confirmed or denied)?

Yes

No

I understand that any omissions or misstatements made by me on this background check form may be cause for my application to be declined. I understand that a Michigan State Police criminal background check will be conducted and all information including conviction or child abuse records will be verified, and hereby consent to such verification. I declare that all the statements I have made on this form are true, correct, and complete to the best of my knowledge. I understand El Grupo Norte Youth Cycling, in their sole and complete discretion, may accept or decline this application without providing me any reasons for the decision. *

I agree

I don't agree

I have submitted my resume and a cover letter to Jobs@norteyouthcycling.org *

Yes

No