Youth Program Application 2020-21 - The Youth Employment Partnership, Inc.

Contact Information

Name (First)*

Name (Last)*

Phone Number*

Email*

Enter Email Confirm Email

Date of Birth*

MM

DD

YYYY

Age*

All participating youth must be 15 on or before July 6, 2020.

What area of Oakland do you live or stay in?*

Home Address*

Street Address Address Line 2 City State ZIP Code

Parent / Guardian Contact Name (if under 18)*

Write "N/A" if 18 or older.

Parent / Guardian Contact Phone Number (if under 18)*

Use your phone number if 18 or older.

Education and Work History

Are you currently a high school student?*

Yes
No

If yes, what high school / alternative school are you attending?*

Write "N/A" if not in high school.

Have you ever attended a job training program?*

Yes
No

If yes, please list the program*

Write "N/A" if never attended a job training program.

What type of work are you interested in? (check all that apply)*

Clerical / Office
Construction / Carpentry
Customer Service / Retail
Outdoor / Environmental
Firefighter / EMT Cadet
Culinary / Kitchen
Computers / Multi-Media
Peer Youth Leader
Warehouse Operations

Additional Assistance

We will not use any of this information to exclude you from participating in our programs. You may be eligible for additional services or jobs based on these criteria. Please check all that apply.

Check all that apply*

Which of the following payroll documents do you have? (Check all that apply)*

Social Security Card
Passport
Birth Certificate
High School Transcript/ Report Card
State ID or Driver's License
None of the above

Is there anything else you would like us to know?

Name

This field is for validation purposes and should be left unchanged.