APPLICATION FOR EMPLOYMENT (UNDER 18)

APPLICATION FOR EMPLOYMENT (UNDER 18)

CAPE MAY COUNTY COUNCIL ON ALCOHOLISM AND DRUG ABUSE INC.,
aka CAPE ASSIST an Equal Opportunity Employer
CHILD'S INFORMATION
Child's Name*

First NameMiddle NameLast Name
Child's Present Address*

Street Address

Street Address Line 2

CityState

Zip Code
Child's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Child's Email*
example@example.com
Child's Social Security:*
How long has child lived at the above address?*

PARENT/LEGAL GUARDIAN INFORMATION
Parent/Legal Guardian's Name*

First NameMiddle NameLast Name
Parent/Legal Guardian's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Legal Guardian's Email*
example@example.com
YesNo
Please enter your NJ license*

CHILD'S MEDICAL
YesNo
If yes, please describe:*
YesNo
If yes, please list medications:*
Person to be notified if case of an emergency*

First NameLast Name
Relationship to child*
Emergency contact phone number*
Please enter a valid phone number.Format: (000) 000-0000.

CHILD'S INFORMATION