Geekcorps Application Form

Geekcorps Registration

	Before you begin make sure you read through our volunteering FAQ
	Fields marked with are required.

The Basics
First Name:
Last Name:
Address


City:
	State: Postal Code: Country:
Primary E-mail:
Alternate E-mail:
Gender:	Male Female
Date of Birth (mm-dd-yyyy)	- -
Do you have a spouse or domestic partner ? Yes No

Now that you're warmed up, a few questions about your Employment History...
Current Employer:
Check here if unemployed
Job Title:
Type of Company:
If "Other," please specify:
Does your employer allow leaves of absences or sabbaticals ? Yes No
Previous Employer:
Job Title:
Type of Company:
If "Other," please specify:
Resume/Curriculum Vitae
If you have an online resume, please enter the URL here. We especially encourage project-based resumes and links to portfolios of your work.

If you don't have an online resume, please paste a copy of your resume in the text box below. Otherwise, we'll be forced to concoct one for you and you probably won't like it.


A question or two on Education...
Please enter the highest degree first.
Degree	Major/Other	School:




Skills and Experience Tell us about your skills. Select top three skills that apply. Use the text box below them to elaborate, indicate skills we have not listed and clue us in on your comfort level with certain areas (i.e. programming languages if you checked programming). We'd love to hear about how you like to bioengineer sheep in your kitchen-but we're really looking for technical, social service, and international skills here.




Tell us about any training you have facilitated.

Have you done any other volunteer work ?

Have you traveled and/or worked in a developing country ? If yes, tell us about it! (Where did you go, what did you do, did you have fun ?)

Even if you have not traveled to the developing world, tell us about encounters you have had with other cultures.


Language Skills	Proficiency


(Others)

Statement of Interest Geekcorps is looking for a cadre of volunteers who are committed to bridging the digital divide one business at a time. We are asking you to be flexible, mature and open to experiences that challenge your personal and professional existence. A statement of interest is your chance to tell us in your own words why in the world you want to do this.

Are you currently registered with the International Executive Service Corps (IESC)? Yes No
How did you hear about Geekcorps?:
Mainstream Media - TV/newspaper/etc. Geek Media - UserFriendly/SlashDot/etc. A friend told me about it. My employer told me about it. Just surfed onto the site Through a volunteer clearinghouse. Saw a booth at a trade show. Other

	.	.
..	..