NYOSCC WIOA ITA Application (Brown-Kelly, Amber)

Newark Youth One-Stop Career Center WIOA Application
Hello Newark Youth Resident,

The City of Newark WIOA (Workforce Innovation and Opportunity Act) & Newark Youth One-Stop Career Center Programs allow Newark youth residents to have an opportunity to experience the workforce, explore vocational training opportunities, obtain a GED and develop professionally.

Please complete the following application in its entire duration.

Click Next to start your application

NEWARK YOUTH ONE-STOP CAREER CENTER

Workforce New Jersey Customer Registration Form
Middle Initial
12. Alternate Phone Number:
13. Fax Number:
17. School Status
What high school did you graduate from?
What college/or university are you attending?
What is your major?
19. Are you receiving financial aid?

YesNo
20. Are you an EOF student?

YesNo
24. What year are you in?

FreshmenSophomoreJuniorSenior
I certify that the information above is true and correct to the best of my knowledge.
Date:

MonthDayYear
Date
Click "Next" unless you need to save and submit later.

Newark Youth One-Stop Career Center Intake Assessment Form
Date:

MonthDayYear
Date
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Address (Number, Street, Apt # if Applicable)
Ex: 500 Broad Street, 3rd Floor
City*
State:*
Zip Code*
Phone Number*
Email Address:*
Ex: john.doe@gmail.com
Gender*

MaleFemale
Selective Service Number (Male Only)
If you are a male ages 18 through 25 and living in the U.S., then you must register with Selective Service. You must supply a Selective Service Registration Card OR Selective Service “Online Receipt” to officially complete your enrollment so that you are eligible for future employment opportunities. If you have not already registered, visit www.sss.gov.
Grade (or last grade completed if Out of School)*
What is your school status?*

In SchoolOut of School
Ethnic Background:*

African AmericanCaucasianAsian or PacificHispanicOther
Emergency Contact Person:
Name*

First NameLast Name
Full Address:*
Ex: 500 Broad Street, 3rd Floor, Newark, NJ 07102
Phone Number*
Relationship*
Click "Next" unless you need to save and submit later.

Income Letter

As an 18 year old and over, and currently not receiving income, you are eligible to sign our WIOA Self- Certification Income Letter. This letter will count as a form of proof of income.
Name*

First NameLast Name
I hereby certify, under penalty of perjury, that the following information is true.
Below, please type: I, "Your full name", currently reside at "Your current full address", with my "Parent/Guardian(s) Full Name" with free room and board.*
Ex: I, John Doe, currently reside at 500 Broad Street, Newark , NJ 07102 with my parents, Jane & Joe Doe with free room and board.
I attest that the information stated above is true and accurate, and understand that the above information if misrepresented, or incomplete, may be grounds for immediate termination and/or penalties as specified by law.
Signature*

Clear
Date

MonthDayYear
Date
Click "Next" unless you need to save and submit later.

Employment Information
What is your current employment status?*

EmployedUnemployed
Have you been employed previously?*

YesNo
If employed, are you employed part-time or full-time?*

Part-TimeFull-Time
Are you a full-time or part-time student?*

Student Full-TimeStudent Part-Time
Employer's Name:*
Address:*
Ex: 500 Broad Street, 3rd Floor, Newark, NJ 07103
Phone Number*
Position:*
Work Schedule:*
Ex: Monday-Friday 8:30AM-4:30PM
Wage:*
Ex: $15/hr
Hours Per Week:*
Ex: 35 hours
Dates Employed:*
Ex: 1/1/2020 to Present
Previous Employer:*
Position:*
Wage:*
Ex: $15/hr
Dates Employed:*
Ex: 1/1/2019 - 3/1/2020
Reasons for Leaving:*
Click "Next" unless you need to save and submit later.

Documentation Submission

In order to be fully assessed for Newark Youth One-Stop Career Center Programs, the following documentation below must be provided. If you do not have all the required documentation, you can submit to your counselor at a later date.
Documentation Checklist

❏ Birth Certificate and/or Active U.S. Passport and/or Active Naturalization Card

** IF BORN OUTSIDE OF UNITED STATES, PLEASE PROVIDE

NATURALIZATION CARD or VALID WORK PERMIT CARD

❏ Social Security Card

❏ Proof of Address- EXAMPLE: Any Bill, Bank Statement (Must Be Dated

within the Last 60 Days) or Current Lease

❏ Income Verification (Three recent pay stubs, 2019 W2 Forms or Award Letter)

❏ Report Card or Diploma

❏ Resume
If you do not have a Printer Scanner, please watch the tutorials below on how to scan your documents using either an iPhone or Andriod Device.

Android Users: Please first download Adobe Scan in Google Play & watch the Adobe Document Scan Tutorial

iPhone Users: Watch Scan your Documents Tutorial

Ensure that each documentation sent is clear and viewable.

Upload your documents below.
Birth Certificate or Active US Passport

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Active Permanent Resident Card (** IF BORN OUTSIDE OF UNITED STATES, PLEASE PROVIDE NATURALIZATION CARD or VALID WORK PERMIT CARD)

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Social Sec. Card

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Proof of Income (Three recent pay stubs, Award Letter)

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Proof of Address (EXAMPLE: Any Bill, Bank Statement (Must Be Dated within the Last 60 Days) or Current Lease) ie. PSEG Bill

Browse Files

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Report Card or Transcripts

Browse Files

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Resume

Browse Files

Cancelof
Upload your files(s) here. Each document submitted will be subject to reviewal by a counselor upon acceptance.*

Browse Files

Cancelof
Click "Next" unless you need to save and submit later.

Agreement
I realize that it is my obligation to assure that my attendance and performance in this program are in compliance with the rules and regulations of the Newark Youth One-Stop Career Center. I am aware that I am required to keep all appointments with my WIOA representative, maintain satisfactory performance and regular attendance. I will actively seek employment; achieve the needed goals as previously agreed upon with my WIOA representative. In addition, provide my WIOA representative with any new personal/contact information. I understand that participating in this program is not an entitlement and services are not guaranteed.

My WIOA Representative will consistently provide guidance and assistance in reaching the goals outlined in this assessment. Any circumstances affecting the successful attainment of this plan will be discussed with my WIOA representative and any modification to this plan will be as a result of a mutual agreement.
Name*

First NameLast Name
Signature:*

Clear
Date:

MonthDayYear
Date
Click "Next" unless you need to save and submit later.

Newark Youth One-Stop Career Center (Youth Information Release Form)
By filling out and signing this Release Form, I am giving The Newark Youth One-Stop Career Center (NYOSCC) permission to refer you to other agencies and services that they deem necessary to help in achieving their goal(s) and to receive information pertaining to their academic performance through the Newark School System and other programs as necessary. The Academic Performance information will include, but not limited to, copies of Report Cards, Progress Reports and Certificate of Completion from High School, and programs.

This information will be requested by a designated representative from The Newark Youth One-Stop Career Center and will be used to update the student’s academic performance status, follow up, and/or additional services that were identified as the participants' needs and goals.

I have read this release, understand all its terms, and execute it voluntarily and with full knowledge of its significance
Name*

First NameLast Name
Date of Birth:*

MonthDayYear
Date
Grade
Parent/Legal Guardian Name:*

First NameLast Name
Cell Phone Number*
Home Phone Number
Work Phone Number
Street Address:*
Ex: 500 Broad Street
City:*
State*
Zip Code*
Signature*

Clear
Date

MonthDayYear
Date
Click "Next" unless you need to save and submit later.

Newark Youth One-Stop Career Center (Image “Use” Authorization Form)
If your child is 14-17 years of age, please read and complete the form below:

I, the parent or guardian of 2020 SYEP youth participant understand that while I participate in the City of Newark Youth One-Stop Career Center’s Program, and any affiliates of the "The City of Newark" may take photographs, video, audiotape, and other image and sound-based media of program activities and its participants. The City of Newark may wish to use such photographs, video, audiotape, and other image and sound-based media for educational, promotional, advertising, and other purposes, without compensation or prior notice.

Therefore, I as a parent and/or guardian of 2020 SYEP youth participant hereby freely and voluntarily consent to the use and publication of my name, the 2020 SYEP youth participant name, participation picture, and/or likeness by the City of Newark and/or its employees and/or agents for any and all purposes including, but not limited to, educational, promotional, advertising and trade, through any medium or format, including, but not limited to, videotape, audiotape, film, photograph, television, radio, digital, internet, theater, or exhibitions, at any time from this date forward. I further waive any claims against the City of Newark and/or its employees and/or agents based upon or related to its use or publication of my likeness, voice, participation, and/or picture.

I freely give this authorization without expectation of compensation.
Participant Name*

First NameLast Name
Participant Signature*

Clear
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Phone Number*
Date

MonthDayYear
Date
Click "Next" unless you need to save and submit later.

Newark Youth One-Stop Career Center (Image “Use” Authorization Form)
If you are 18-24 years of age, please read and complete the form below:

I understand that while I participate in the City of Newark Youth One-Stop Career Center Program, and any affiliates of the "The City of Newark" may take photographs, video, audiotape, and other image and sound-based media of program activities and its participants. The City of Newark may wish to use such photographs, video, audiotape, and other image and sound-based media for educational, promotional, advertising, and other purposes, without compensation or prior notice.

Therefore, I hereby freely and voluntarily consent to the use and publication of my name, participation, picture, and/ or likeness by the City of Newark and/ or its employees and/or agents for any and all purposes including, but not limited to, educational, promotional, advertising, and trade, through any medium or format, including, but not limited to, videotape, audiotape, film, photograph, television, radio, digital, internet, theater, or exhibition, at any time from this date forward. I further waive any claims against the City of Newark and/or its employees and/or agents based upon or related to its use or publication of my likeness, voice, participation, and/ or picture.

I freely give this authorization without expectation of compensation.

I am 18 years of age or older, and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.
Name*

First NameLast Name
Signature*

Clear
Primary Phone Number*
Date

MonthDayYear
Date
Click "Next" unless you need to save and submit later.

RIASEC Career Pathways

Based on the three letters with highest score, you can explore career pathways below that maybe suitable to you.
R = Realistic

These people are often good at mechanical or athletic jobs. Good college majors for Realistic people are…
- Agriculture
- Health Assistant
- Computers
- Construction
- Mechanic/Machinist
- Engineering
- Food & Hospitality
Related Career Pathways

Natural Resources

Health Services

Industrial & Engineering Technology

Arts & Communication
I = Investigative

These people like to watch, learn, analyze, and solve problems. Good college majors for Investigative people are…
- Marine Biology
- Engineering
- Chemistry
- Zoology
- Medicine/Surgery
- Consumer Economics
- Psychology
Related Career Pathways

Health Services

Business

Public & Human Services

Industrial & Engineering Technology
A = Artistic

These people like to work in unstructured situations where they can use their creativity. Good college majors for Artistic People are...
- Communications
- Cosmetology
- Fine & Performing Arts
- Photography
- Radio & TV
- Interior Design
- Architecture
Related Career Pathways

Public & Human Services

Arts & Communication
S = Social

These people like to work with other people, rather than things. Good college majors for Social people are…
- Counseling
- Nursing
- Physical Therapy
- Travel
- Advertising
- Public Relations
- Education
Related Career Pathways

Health Services

Public & Human Services
E = Enterprising

These people like to work with others and enjoy persuading and performing. Good college majors for Enterprising people are
- Fashion Merchandising
- Real Estate
- Marketing Sales
- Law
- Political Science
- International Trade
- Banking/Finance
Related Career Pathways

Business

Public & Human Services

Arts & Communication
C = Conventional

These people are very detail-oriented, organized, and like to work with data. Good college majors for Conventional people are…
- Accounting
- Court Reporting
- Insurance
- Administration
- Medical Records
- Banking
- Data Processing
Related Career Pathways

Health Services

Business

Industrial & Engineering Technology
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Grievance Procedures
To protect your rights and privileges as a participant, a grievance procedure has been established to help resolve problems when a participant feels they have been treated unfairly. Participants are required to make every effort possible to resolve any problem they have with the Newark One-Stop Career Center staff. If a grievance has not been resolved to a participant’s satisfaction, write or contact directly:

MARSHA ARMSTRONG, DIRECTOR
NEWARK YOUTH ONE-STOP CAREER CENTER
500 Broad Street; 3rd Floor
Newark, New Jersey 07102
Tel: (973) 273-6064

Newark Youth One-Stop Career Center will investigate the matter and make a decision. If a participant is not satisfied with the decision, that participant will have 30 days to appeal in writing to:

DAVETTA LANE, DIRECTOR OF OPERATIONS
NEWARK YOUTH ONE-STOP CAREER CENTER
990 Broad Street; 1st Floor
Newark, New Jersey 07102
Tel: (973) 733-8500
Participant Name*

First NameLast Name
Date

MonthDayYear
Date
Participant Signature*

Clear
Date

MonthDayYear
Date
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Click "SUBMIT" to fully submit your application
Should be Empty:

Newark Youth One-Stop Career Center WIOA Application

New Jersey Intake & Initial Assessment Form

Employment Preferences

Certificate/Special Licenses:

Driver's License

NEWARK YOUTH ONE-STOP CAREER CENTER

Newark Youth One-Stop Career Center Intake Assessment Form

Family Information & Household Income

Household Income:

Income Letter

Family Health Information

Transportation Information

Education Assessment/Job Training:

Employment Information

Personal Information

Documentation Submission

Agreement

Newark Youth One-Stop Career Center (Youth Information Release Form)

Newark Youth One-Stop Career Center (Image “Use” Authorization Form)

Newark Youth One-Stop Career Center (Image “Use” Authorization Form)

The RIASEC Test

RIASEC Career Pathways

Grievance Procedures

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