Youth Career Center Application

Youth Career Center Application

This is an application for a job-training program - NOT for employment. Some questions are not allowed on an Employment Application.
YOUTH INFORMATION
I am interested in learning more about the following:
Are you a permanent resident of the State of Rhode Island? Candidates must be a permanent resident of the State of Rhode Island to participate.*

YesNo
Are you between the ages of 14 and 24, or are you a student in grade 6, 7 or 8*

YesNo
The Tri-County Employment & Training Department operates three different Career Center locations where we offer free year round career exploration and work preparation services for young adults. All participants in our program must be affiliated with a specific Career Center location. Although the programs and services that you receive this summer may be completely virtual, we are still required to maintain a paper based client file for all program participants at one of our Career Center locations. Please select which Career Center location you would like to be affiliated with. Your affiliation selection does not limit you to receive services from this specific site (program participants are still eligible to receive services at any of our locations):*
Name*

First NameMiddle InitialLast Name
Date of Birth:*

MonthDayYear
Date
Street:*
City:*
State: *
Must be a permanent resident of the State of Rhode Island to participate.
Zip Code:*
Gender

MaleFemaleOtherI do not wish to answer
I am authorized to work in the U.S due to the following reason:*

Citizen of U.S or U.S TerritoryAlien/Refugee Lawfully Admitted to U.SU.S Permanent Resident
Employment Status:*

EmployedNot Employed
Race:
Ethnic Origin:

Hispanic or LatinoNot Hispanic or LatinoI do not wish to answer
Race:

WhiteAmerican Indian/Alaskan NativeHawaiian/Other Pacific IslanderAfrican American/BlackAsianMulti-RacialOtherI do not wish to answer
EDUCATION INFORMATION
(If a summer applicant, use current school name and grade for the coming fall)
Last Grade Completed:*
Current School Name:*
Current Grade:*
Current School Status:*

In School H.S. or belowIn School Post H.SNot in school, H.S graduateNot in school, did not graduate
Contact Information
Primary Phone Number:*
Secondary Phone Number:
Email Address:*
example@example.com
Alternative Contact Name:*
Phone:*
APPLICANT ASSURANCES/SIGNATURES
The information on this application is true to the best of my knowledge. I realize that any false statement I knowingly made may cause this application to be rejected or may result in my termination from the program. I also understand that I am not guaranteed employment or any other services. I agree that the information on this form, as well as information collected during my participation in the program, may be transmitted to the Rhode Island Governor's Workforce Board (GWB) or other agencies to track short and long-term outcomes as determined by the GWB or its affiliates.

I agree that the information on this form, as well as information collected during my participation in the program, may be transmitted to the DLT/GWB or other agencies to track short- and long-term outcomes as determined by DLT/GWB or affiliates.
APPLICANT SIGNATURE:*

Clear
DATE:*

MonthDayYear
Date
PARENT/GUARDIAN SIGNATURE (If applicant is under 18):*

Clear
DATE:*

MonthDayYear
Date
This project was funded in whole or in part through funds received from Real Skills for Youth, an initiative of the Governor’s Workforce Board.
Type a question
Should be Empty:

Youth Career Center Application

YOUTH INFORMATION

Race:

EDUCATION INFORMATION

Contact Information

APPLICANT ASSURANCES/SIGNATURES