Youth Employment Program

Personal Information

Legal First and Last Name

Preferred Name

Birth Date

Grade
—Please choose an option—89101112

Have you completed the Young Worker Readiness Certificate Course? (Students aged 14 & 15 are required to have this completed. If 16 years of age or older, this is not required.
YesNoNot applicable, I am 16 years of age or older.
Please upload Certificate of Completion here:

Phone Number

Email Address

Street Address

City

Province

Postal Code

Parent / Guardian Name

Relationship to Parent / Guardian (Mother, Father, Other: Please Specify)

Parent / Guardian Phone Number

Parent / Guardian Email

Do you foresee any barriers that The Center could accommodate to ensure success within this role?
YesNo

If yes, please specify

School & Extracurricular Information

Name of school currently attending

Academic awards and/or honors you have received in school or extracurriculars

Are you a member of any clubs or organizations in or outside of school? If yes, please detail what and your role.

Do you volunteer within the community? If yes, please state where and in what capacity.

Please detail any previous work experience (place of employment, date employed, etc.)

Please list skills that you have that would be applicable to this role.

References

Reference 1 Name

Reference 1 Phone Number

Reference 1 Email

Reference 2 Name

Reference 2 Phone Number

Reference 2 Email

Reference 3 Name

Reference 3 Phone Number

Reference 3 Email

If you have a resume, please upload it here:

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