Alternative Break Opportunity

*Items in bold with an asterisk are required.
*First Name:
Middle Initial:
*Last Name:
*Email Address:
*Zip: (xxxxx-xxxx)
*Phone: (xxx-xxx-xxxx)
Alternative Phone: (xxx-xxx-xxxx)
Is anyone in your family an AFSCME member?:
*1. Which session would you like to attend?
*2. How did you find out about this opportunity?
Please specify in more detail how you found out about us. (255 chars max)
3.What college or university do you attend?
4.What is your major?
5.What is your expected graduation date?
Month: Year:
6.What are you hoping to get out of AFSCME's Alternative Break and how does it fit with your career goals?
7.Union organizing is a social justice movement. What social justice issues are you most concerned about and how have you acted on those concerns?
8. This program is for students who are seriously considering a career in the labor movement. Why do you want to be a union organizer?
9. Describe any community, political, union or student organizing or social activist groups that you have volunteered or worked with. What was your role?
10. AFSCME's Alternative Break program will be an intense week with long and irregular hours working with a diverse group of students. Have you ever gone through such an experience? If yes, please explain. (255 chars max)
11. Please list two references, title, organization and relationship to you. Include contact information.
12. In addition to English, what other languages do you speak fluently? (255 chars max)
13. Do you have a driver's license?
14. Please upload your résumé here:

(Résumé must be less than 1MB and be of file type .pdf, .doc, .docx, or .txt)
This information is used to help ensure that AFSCME's personnel practices comply with regulations under federal law. Your responses are voluntary for pre-employment application. However, the completion of these questions will be a requirement should you be selected for this position. Failure to provide this information will have no effect on you or your employment. Should you decline to complete this form, an attempt will be made to identify your race or ethnic category by visual observation.

The categories below describe basic racial and national origins. No person shall be counted in more than one race/ethnic group.
Race or Ethnic Category: