Chemung County Youth Bureau Employment Application

Chemung County Youth Bureau Employment Application

599 Harris Hill Road, Elmira, NY 14903, 607-737-2907
Program & Position Applied For *
You must be at least 17 years of age by July 1st to be eligible to apply for Summer Cohesion
You must be at least 18 years of age to be eligible to apply for Spot
You must be at least 15 years of age to be eligible to apply for Super Saturday
You must be at least 21 years of age to be eligible to apply for JAWS
Name *

First Name Middle Inital Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Type of Phone *

Cell Land Line
Phone Number *
Type of Phone

Cell Land Line
Phone Number
Social Security Number *
Email *
example@example.com
Are you under 18 years of age *

Yes No
If yes, enter your Birth Date

Month Day Year

Provide the school district, city/town/village, county and state of which you are an actual permanent legal resident and indicate how long you have been residing continually, up to and including the date of this application. (You must enter a value in EACH cell) *

	Name	Years	Months
School District
City/Town/Village
County
State

Were you ever dismissed or discharged from any employment for reasons other than lack of work or funds? *

Yes No
Did you ever resign from any employment rather than face dismissal? *

Yes No
Did you ever receive a discharge from the Armed Forces of the United States which was other than “Honorable” or which was issued under other than honorable circumstances? *

Yes No
Have you ever been convicted of a crime (felony or misdemeanor)? *

Yes No
Have you ever forfeited bail bond posted to guarantee your appearance in court to answer to any criminal charges? *

Yes No
Are you now indicted for any crime (felony or misdemeanor)? *

Yes No
Education and Certifications

List your current certifications

	First Aid	CPR	Other
Type
Date Issued

Work Experience
Do you have work experience? *

Yes No
Please list your most recent positions.
Name of Employer
Position
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Employer Phone Number
Start Date of Employment
MM-DD-YYYY
End Date of Employment
MM-DD-YYYY
Name of Employer
Position
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Employer Phone Number
Start Date of Employment
MM-DD-YYYY
End Date of Employment
MM-DD-YYYY
Have you worked for Chemung County Youth Bureau before? *

Yes No
If yes, what program(s), when, and location(s)?
Indicate all experiences you have working with youth

Teacher Sports Drama Arts & Crafts Nature/Outdoors Music Babysitting
What age group(s) do you prefer to work with?

4-5 years 6-7 years 8-9 years 10-12 years 13-15 years 16-18 years
How did you hear about this position? *
How did you hear about this position? *
Letters of Recommendation:
Submitting two letters of recommendation is a part of the employment application process with the Chemung County Youth Bureau. Without your two letters of recommendation your application will be considered incomplete and will not be processed.

If you have never worked another job before you could ask a teacher or guidance counselor in your school who knows you to write a letter of recommendation for you. If you have had another job or jobs you can ask your previous manager or boss to write a letter of recommendation for you. Typically a letter of recommendation will speak to what a good worker you were or speak to some of your character traits such as being on time, a positive person or likes people.

If you should need some guidance or assistance with your letters of reference, please contact the Chemung County Youth Bureau. We would be happy to help.
1st Letter of Recommendation

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2nd Letter of Recommendation

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- Chemung County Youth Bureau is an Equal Opportunity Employer -

– Applications will be kept on file for one (1) calendar year –
– Incomplete Applications will not be processed –
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Chemung County Youth Bureau Employment Application

Education and Certifications

Work Experience