Young Adult Culinary Academy Application

Youth Guidance Culinary Academy Application
Personal Information
First Name:*
Middle Initial:
Last Name:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Format: (000) 000-0000.
Email:*
example@example.com
Date of Birth:*

MonthDayYear
Date
What is your current age?*
What is your gender?*

MaleFemale
National Origin:*

AsianBlackHispanicWhiteAmerican IndianOther
Do you have a state-issued Driver's License?*

YesNo
Do you have reliable transportation?*

YesNo
Emergency Contact Name:*
Emergency Contact Cell Phone Number:*
Format: (000) 000-0000.
Emergency Contact Email:*
example@example.com
Do you have any health and physical issues that would prevent you from using heavy machinery?*

YesNo
Number of Individuals in Household:*
Annual Household Income:*
Are you a United States citizen?*

YesNo
Education (please select highest grade completed):*

12345678910111213 (Postsecondary Level/College)14 (Postsecondary Level/College)15 (Postsecondary Level/College)16 (Postsecondary Level/College)
Diploma issued in the USA:*

H.S.GEDNo
Name of Last School Attended:*
Are you a Veteran?*

YesNo
Culinary Training & Employment History
If the answer to the first question is No, please put N/A or use zeroes in place of numbers for the remaining questions.
Are you currently employed?*

YesNo
Name of Previous or Current Employer:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor's Name:*

First NameLast Name
Telephone:*
Please enter a valid phone number.Format: (000) 000-0000.
Have you ever had Apprenticeship Training?*

YesNo
If Yes, what trade?*
List all education and work experience you have related to the Food Service Industry:*
Have you ever been convicted of a felony?*

YesNo
If yes, please explain:
I hereby swear and affirm that all of the above information is true and I understand that any false information given will result in immediate dismissal from the program.

Parent or guardian signature if student is under age 18.
Signature:*
Print Name:*
Today's Date:*

MonthDayYear
Date
Once the application has been processed, you will be contacted within 2-3 business days using the contact information provided. You'll be asked to sign all documents at the time of enrollment.
Should be Empty:

Youth Guidance Culinary Academy Application

Personal Information

Culinary Training & Employment History