Apply Now - Summer Jobs 253

APPLICANT INFORMATION – ALL INFORMATION MUST BE CLEARLY PRINTED.
Full Legal Name:
Date of birth Mo/Day/Yr:
Age:
SSN:
Ethnicity:
Street Address:
Gender:
Male
Female
Prefer not to say
City:
State:
ZIP Code:
Email:
Home Phone:
Cell Phone:
Are you a citizen of the United States? YES
NO
If no, are you legally authorized to work in the U.S.? YES
NO
SCHOOL INFORMATION
School (Tacoma Public School Required):
Address:
Expected Graduation Date (Mo, Yr):
*June, 2015 Graduates are not eligible.
Current Grade level:
Do you have a documented disability/IEP? YES
Phone:
If yes, will you need accommodations on the work site? YES
NO
Please explain:
_________________________________________________________
NO
GPA:
Are you currently credit deficient? YES
History of disciplinary actions:
Have you ever reported to
Truancy Court?
YES
NO
NO
Are you currently or have you ever
been in Foster Care? YES
NO
AVAILABILITY
nd
SJ253 mandatory 20-hour orientation week: June 22 , 2015 – June 26th, 2015
SJ253 work calendar: July 1st, 2015 – August 14th, 2015
Please list the hours of your availability:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
From
To
Comments concerning availability:
_________________________________________________________________________________________________
Do you have summer vacation plans? YES
Do you plan to attend summer school?
Are you presently employed? YES
YES
NO
NO
NO
If yes, when?:
_________________________________________________________
If yes, where? ________________________________________________________
CERTIFICATIONS (EXAMPLES: WA FOOD HANDLER CARD, CPR, ETC.)
1.
2.
Do you have a valid WA Driver’s License? YES
NO
Will you need assistance with transportation to work? YES
Do you live near a bus line? YES
NO
NO
SKILLS INVENTORY – PLEASE CHECK SKILLS RELATED TO YOUR ABILITY
Working Outdoors
Food Service
Providing Customer Service
Basic Typing and/or Data Entry
Fire/Emergency Training
Operating Phone Systems
Working with Children
Gardening/Landscaping
Working in an Office Setting
Managing Inventory
Microsoft Office (Word, Excel)
Creating Arts and Crafts
EMPLOYMENT HISTORY
Employer:
From (Mo/Yr):
To (Mo/Yr):
Position:
Employer’s Phone:
/
/
Employer’s Address:
Description of Job Duties:
Reason for Leaving:
EMERGENCY CONTACT
Name of Emergency Contact:
Emergency Contact’s Address:
Relationship to you:
Emergency Contact’s Phone:
TEACHER REFERENCES (AT LEAST TWO) – REQUIRED
Teacher’s Printed Name
Teacher’s Email Address:
Teacher’s Signature:
1.
2.
ESSAY
ESSAY PROMPT: Why is participating in the Summer Jobs 253 internship program important to you?
Instructions: As you respond to the essay prompt, think about who will read your statement and what you want them to
understand about you. While your personal statement is only one of many factors we consider when making our
acceptance decision, it helps provide context for the rest of your application.


Essays must be typed, double spaced, and a minimum of 650 words.
Please attach your completed essay to the Summer Jobs 253 student application.
PARENT/GUARDIAN SIGNATURES
I certify that the information provided is accurate and complete to the best of my knowledge. I understand that any falsification may cancel any terms, conditions or privileges of
employment. I understand submitting a completed application does not guarantee placement in the Summer Jobs 253 program and late applications will not be considered.
Signature of applicant:
Date:
Signature of parent/guardian:
Date:
Application Deadline: Tuesday, March 31st, 2015
Please return the completed Summer Jobs 253 application to your career counselor.
Late applications will not be considered.