Completing this application does not guarantee employment

1 Robert L. Bowser, Mayor City of East Orange East Orange City Council Thank You for your interest in the 2010 Youth Summer employment Program. The primary mission of the youth summer employment program is to provide you with an introduction to the World-of-Work. Upon entry into the program you will be required to meet with an employment Associate for an interview and to discuss job options as well as participate in Work Readiness Workshops. Let s get real. We all need cash. Whether you are saving money for a car, college, that new pair of sneakers, or planning your career, getting a job is important. Yet finding that first job can be difficult. Employers want to hire someone with experience, but how do you get it? The Youth 2000 Initiative has the solution. First you must fill out the attached application . Below are the requirements for completion of the application . Please note that the processing of incomplete applications will be delayed.

2 You must be at least 14 years of age You must live in East Orange You must sign and have your parent or guardian sign this application if you are under 18 Make sure you fill in all blank spaces telephone number, date of application and social security number You must have a social security card You must have a US birth certificate or US passport Return completed applications to this office Participants aged 14-15 will only qualify for the Summer Work Experience Program Participants 16-18 will qualify for both the Summer Work Experience Program and Y2 Private Sector Program. In addition a typed resume must be submitted. Participants must attend & complete the work readiness workshops to receive any job referrals or placement. employment IS NOT GUARANTEED. Completing this application does not guarantee employment ; however, it places you in our database for the 2010 Youth Summer employment Program. If you have any questions or concerns please contact the Division of employment & Training at 973-677-8914 or email us at CITY OF EAST ORANGE Department of Health & Human Services Division of employment & Training Youth 2000 Initiative Program 7 Glenwood Avenue, Suite 100 East Orange, New Jersey 07017 PH: (973) 677-8914 Fax: (973) 673-8561 2010 YOUTH SUMMER EMPOLYMENT PROGRAMS PLEASE NOTE: employment IS NOT GUARANTEED PERSONAL INFORMATION: REFERRED BY:_____ DATE:_____ NAME:_____ PHONE#_____ ADDRESS:_____APT#_____ CITY:_____STATE:_____ZIP CODE:_____ DATE OF BIRTH:_____AGE:_____EMAIL:_____ DO YOU HAVE A VALID DRIVER S LICENSE?

3 ____YES ___NO DO YOU HAVE A VEHICLE? ___YES ___NO EDUCATIONAL BACKGROUND: HIGH SCHOOL:_____ LOCATION:_____ _____FRESHMAN ____SOPHMORE ___JUNIOR ____SENIOR ____GRADUATED ARE YOU CURRENTLY ENROLLED IN SCHOOL? ____YES ____NO GED PROGRAM:_____ ORGANIZATION AFFILIATIONS:_____ DO YOU HAVE ANY SPECIAL CERTIFICATES? _____ PERSONAL BACKGROUND INFORMATION: HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENSE? ____YES ___NO IF YES, EXPLAIN:_____ ARE YOU WILLING TO UNDERGO A PHYSICAL, DRUG SCREENING AND BACKGROUND CHECK? _____YES ____NO -over- INTERNSHIP OR VOLUNTEER WORK: COMPANY NAME:_____LOCATION:_____ TITLE OF INTERNSHIP:_____ DATES FROM:_____TO:_____ WAS THE INTERNSHIP? _____NON PAID or ____PAID - SALARY:_____ JOB RESPONSIBILITIES/DUTIES:_____ _____ SUPERVISOR:_____PHONE NUMBER:_____ WORK HISTORY: HAVE YOU EVER BEEN A PARTICIPANT IN OUR SUMMER WORK EXPERIENCE PROGRAM? ___Yes __ NO WORKSITE NAME: _____ TITLE/POSITION: _____ DATES OF employment : FROM:_____ TO:_____ JOB RESPONSIBILITIES/DUTIES:_____ _____ SUPERVISOR:_____ Most recent employer: COMPANY NAME:_____LOCATION:_____ TITLE/POSITION:_____RATE OF PAY:_____ DATES OF employment : FROM:_____ TO:_____ JOB RESPONSIBILITIES/DUTIES:_____ _____ REASON FOR LEAVING:_____ SUPERVISOR:_____PHONE NUMBER:_____ I certify that all of the above information is correct and accurate to the best of my knowledge.

4 Please be advised that Completing this profile does not guarantee employment . Applicant s Name:_____Date:_____ PARENT S SIGNATURE NEEDED ONLY IF UNDER 18 YEARS OLD Parent/Guardian Signature:_____Date:_____ CITY OF EAST ORANGE Department of Health & Human Services Mayor s Office of employment & Training 7 Glenwood Avenue, Suite 100 East Orange, New Jersey NATIONAL SCHOOL LUNCH ACT INQUIRY FORM Name: _____ School Attending: _____ Location: _____ Age: _____ (Circle one) Grade Level: 7th 8th 9th 10th 11th 12th Are you currently participating in the National School Lunch Program? ____ Yes _____ No Are you receiving reduced lunch as part of the National School Lunch Program? ____ Yes _____ No Signature: _____ Date: _____ City of East Orange Mayor s Office of employment & Training Youth 2000 Initiative