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Youth Development Services

Job Assist Student/Young Adult Application

Job Assist Application

You may either download and mail the application or complete the form online. Youth under age 18 must provide their parent/guardian's contact information so we can receive verbal permission for you to participate in this program.

Student/Young Adult Application

First Name *
Last Name *
School District
If no longer in school, please type "NA"
Month
/
Day
/
Year
Country
Address Line 1 *
City *
State/Province *
Postal Code *
If you don't have a home phone, please type "NA"
If you don't have a cell phone, please type "NA"
If you are age 18 or older, names are not required. Please type "N/A."
Do you have a valid Driver's License?
Do you have your Working Papers?
Do you have access to reliable 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.
Month
/
Day
/
Year

YOUTH UNDER 18:  Please note that a Job Assist Coordinator will reach out to your parent/guardian to receive verbal permission for you to participate in the Job Assist Program.

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