Youth Apprenticeship Application Form

Today’s Date ______________ Pathway___________________ School_______________________

Full Name: ___________________________________________________ Graduation year _____

Address: ______________________________City:_________________ Zip Code: ________

Home phone: _______________ Cell: _________________Email:__________________________

Birth Date: __________________

Do you participate in Extra- Curricular Activities? Yes ___ No ___ Which? __________________
List previous work experience, if any (starting with the most recent and working backwards):

Job Title Employer (Name)

______________________________ __________________________________
______________________________ ___________________________________

Are you available for summer employment? Yes ____ No ____

Can you drive to work? Yes __ No __ If not, do you have transportation? Yes __No __
What are your plans after high school graduation? ____________________________________________
Parent Contact Information
Primary Guardians name _________________________________ Phone # _______________________

Email address ______________________________

Other Guardians Name __________________________________ Phone # ________________________

Email address ______________________________

Special Skills
I am familiar with the following: Check all that apply.

Word __Excel__Powerpoint __AutoCAD __Typing __Filing __ Access ___Other special skill(s)________________

SLP student? _____yes _____no Completed Explore Post? ____yes ____no

Certified in: Word _____ Excel _____ Powerpoint ____ Other __________________