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What's New

This year the income section of the Summer Youth Application

must be completed in order to submit.

SUMMER YOUTH EMPLOYMENT PROGRAM APPLICATION

Income restrictions may apply. An equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. All voice telephone numbers on this document may be reached by person using TTY/TTD equipment via the Florida Relay Service at 711. A proud partner of the American Job Center network.

In addition to these county positions we will be offering additional positions through community partners.
Please select yes if you would be interested in interviewing for these other positions if not selected for the two you have chosen. Yes   No


Birthdate    Age    Last Grade Completed    Last 4 Numbers of Social Security Number

First Name

     MI 

     Last Name

Email Address

Street No

          Street Suffix

City

County*

     State   Zip

Home Number**

Cell Number**
  * This program is available for Leon County residents only.
  ** At least one phone number is required.
WORKFORCE INNOVATION & OPPORTUNITY ACT ELIGIBILITY The Summer Youth Training Program is funded in part by the Workforce Innovation & Opportunity Act (WIOA) Youth Grant. Please complete the following questions to help us determine whether you meet WIOA eligibility requirements for youth. The more accurate the information you provide, the easier it will be for us to enroll you in the program. All of the information collected is confidential.
Are you a U.S. Citizen ? Yes   No     If no, do you possess an I-151, an I-1551, or an I-94 card stamped "Employment Authorized?" Yes   No
**How many people are in your family/household including yourself?
(Required) 		**Please select the income range for your total family/household.
(Required)
Are currently attending high school? Yes   No If yes, what is your anticipated graduation date month and year?
Are currently attending or registered for classes at a post-secondary education institution? Yes   No If yes, please list the name of the institution.
In the past 6 months has your family received assistance through the supplemental nutrition assistance program (SNAP), or the supplemental security income program established under Title XVI of the Social Security Act, or any other State or local income-based public assistance? Yes   No
   Check all that apply:
 I am an English Language Learner
I have been arrested or convicted of any crimes
I have an Individualized Education Plan (IEP) or have a documented disability
I am currently homeless, am a runaway, or am in an out-of-home placement
I am currently in foster care or have been in foster care
I am pregnant or a parenting youth

  EDUCATION

Level Institution 
Name 		Major Level
Completed 		Graduated Degree
Elementary Yes   No
Middle Yes   No
High 
School		 Yes   No
College or
University		 Yes   No
WORK RECORD
Job Title Specific Duties
Company/Sponsor
City/State
Supervisor's Name
Date Employed From   To
Hours Worked/Week   Salary $/
Phone Number
 
Job Title Specific Duties
Company/Sponsor
City/State
Supervisor's Name
Date Employed From   To
Hours Worked/ Week   Salary $/
Phone Number
 
Job Title Specific Duties
Company/Sponsor
City/State
Supervisor's Name
Date Employed From   To
Hours Worked/ Week   Salary $/
Phone Number
 
Job Title Specific Duties
Company/Sponsor
City/State
Supervisor's Name
Date Employed From   To
Hours Worked/ Week   Salary $/
Phone Number
OFFICE SKILLS
  (Please indicate areas of competency.)		    OTHER SKILL AREAS  
(Please list any other relevant skills - Paid or Unpaid) 
Computer: Word Processing Filing
Computer: Spreadsheets Shorthand WPM:
Computer: Databases Typing WPM:
Specific Software Expertise:
  
CERTIFICATE OF APPLICANT
I hereby certify that all statements made in this application and any attachments to it are true. I understand that any misstatement, misrepresentation or omission of fact may cause my application not to be considered; or, if I have been employed, may cause for my immediate dismissal. By submitting this application, I am giving Leon County permission to share a copy of this application with CareerSource Capital Region and Dynamic Workforce Solutions. I authorize Leon County and CareerSource Capital Region to verify information contained in this application and attachments. I further authorize anyone having such information to release it. I understand that if I am selected for this position and I am 18 years old or older, prior to employment, a criminal history screening of my background may be conducted. I further understand that, if I am selected for employment, prior to appointment, depending on the position I receive I may be required to successfully pass a pre-employment drug test. I also understand and acknowledge that I am applying for a position in the Leon County Summer Youth Training Program. If I am selected for a position, I understand that I will be a participant in the Leon County Summer Youth Training Program and not an employee of Leon County.
Check here to indicate that you have read and agree to the CERTIFICATE OF APPLICANT.

* Signature of Applicant
Date:5/2/2024