YOUTH SUMMER EMPLOYMENT EXPERIENCE APPLICATION

Applications will be accepted until May 4th. for questions or concerns, contact ERNESTINE REESE at CONGAREECOMPLEXCDC@GMAIL.COM OR CALL 803-206-8617

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Age

Grade

School

Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Emergency Contact Name

First Name

Last Name

Phone

(###)

###

####

Insurance Company

Health Insurance Policy #

Work Experience

This should include all work such as babysitting, cutting grass, general household chores, etc.

Have you ever worked?

Yes

If yes, when did you work?

Where did you work?

Supervisor's Name

First Name

Last Name

Supervisor's Phone

(###)

###

####

Community Involvement, Activities, and Awards

Church Membership

If you have been involved in any community or school activities or received any special awards list them below.

Expressions

Write an essay; 1-2 paragraphs responding to the following questions.

Why do you want to work this summer?

What careers are you interested in choosing and why?