JOB ASSIST STUDENT/YOUNG ADULT APPLICATION

You may either download and mail the application or complete the form online. Youth under age 18 must download and print the application below for their parent/guardian's signature.  Please do not complete the online form if you're under the age of 18.

Student/Young Adult Application

First Name
Last Name
School District
School District Where You Reside
School
Current Grade
If no longer in school, please type "NA"
Date of Birth
/
/
Age
Note: Youth under the age of 18 must download and print the application. See above.
Country
Address Line 1
City
State
Postal Code
Home Phone
If you don't have a home phone, please type "NA"
Cell Phone
If you don't have a cell phone, please type "NA"
Parent/Guardian Name(s)
If you are age 18 or older, names are not required. Please type "N/A."
Driver's License
Do you have a valid NYS Driver's License?
Working Papers
Do you have working papers?
Transportation
Do you have access to transportation?
Mode of Transportation
Ethnicity
For funding purposes, please indicate ethnicity.
Choose which job categories interest you.
Do you have any special certifications or trainings that would be applicable to a job?
Do you have any special skills or hobbies?
Please type your full name to sign.
Date
/
/

YOUTH UNDER 18:  Please note that you must download and print an application for your parent/guardian to sign and return to CAPTAIN CHS.  The link to download the file is at the top of the page.