KEYS 2023: Summer Youth Employment
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First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Age as of June 1, 2023
*Applicants must be at least 16 years old by June 1, 2023 to participate in Work Experiences *
Gender
Gender Pronouns:
Race/Ethnicity (Mark all that apply.) *
Required
Zip Code *
Primary Telephone Number
*Please list the main phone number where we can reach you directly.
 *
What type of phone number was listed above? *
Alternate Phone Number
*Please list the secondary phone number where we can reach you if there is no response at primary number.
 *
What type of phone number was listed above? *
Email Address
*Please list a valid email address for an account monitored by the applicant. This is the email address that KEYS Staff will use to contact the applicant regarding the status of the application. 
*Do not list an account that is not monitored or an account that belongs to someone else. If you do not have an email, please indicate "Not Applicable". Do not use your high school email as this is not active over the summer months.
 *
Do you have the following documents?

 *
YES
NO
Not currently but I have requested a replacement.
Not currently and I do not know how to request a replacement.
Birth Certificate
Government Issued ID (Student ID with picture, Driver's License, Military ID, Passport)
Social Security Card
What industry are you interested in obtaining employment in for the KEYS Summer Employment Program?
*You may select multiple industries if you have more than one career interest. Please note that this does not guarantee a position in the industry selected, but will be used to recruit employers to participate.
 *
Required
Please mark the following statements if they apply to you.  You can mark multiple statements if they apply. The KEYS Staff can work with you and have resources to address any barriers you identify.
 *
Required
Are you currently enrolled in an educational program? *
Grade level as of May 1, 2023.
List school attended as of May 1, 2023.
*Please leave blank if not currently attending.
I attest that the information stated above is true and accurate, and understand that the above information, if misrepresented or incomplete, may be grounds for immediate termination and/or penalties as specified by law.  
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