LVJUSD YouthBuild Application

To apply for the YouthBuild program, please complete the application below.

Applicant Information

Applicant's First Name *

Last Name *

Date of Birth *

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Age *

Gender *

Ethnicity *

Residence Address *

Phone Number *

Emergency Contact Name *

Relationship *

Home Phone # *

Cell Phone # *

Education

What is the last school you attended? *

What is the last year you attended school? *

What is the highest grade you completed? *

Do you have an IEP or 504?

If you did not complete high school or get your GED, why did you drop out?

If completing your GED or HiSET, are you currently enrolled in any of these programs? *

Do you want to attend college? *

If yes, will you be the first generation in your family to attend college?

Once you finish YouthBuild, would you be interested in applying for an apprenticeship? *

Student Personal Profile

Are you currently in or have you been in Foster Care ? *

If yes, please list the name of your social worker.

Have you ever been convicted of a crime? *

If yes, please indicate crime, dates and status of case:

Do you have a probation/parole officer? *

If yes, please indicate the name of your probation/parole officer:

Have you ever served in the U.S. Military? *

If yes, please indicate the branch, rank and discharge date:

Do you have any physical, medical or health problems? *

If yes, please describe:

Do you have a driver’s license? *

Do you own a car? *

How do you plan on getting to and from the program? *

How did you hear about YouthBuild?

Construction Experience

Do you have construction experience? *

If yes, please describe your construction experience:

YouthBuild offers industry certifications in both construction and welding. Please indicate your primary program of interest: *

If you are interested in a career other than construction or welding, would you be interested in an 8-week Careers Academy that focuses on overall job seeking skills? *

Employment History

Have you ever had a job before? *

If you've had a job, please complete the following:

Most recent job position:

Starting date

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Ending date

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Duties included:

Reason for leaving:

Second most recent job position:

Starting date:

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Ending date:

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Duties included:

Reason for leaving:

Personal References

Please list up to two references (employers, teachers, etc.) who may know your abilities:

Reference #1: Name *

Phone number *

Relationship *

Reference #2: Name *

Phone number *

Relationship *

APPLICANT’S ACKNOWLEDGEMENT

I certify that answers given in this application are true and complete to the best of my knowledge. I authorize investigation into all statements I have made on the application as may be necessary for reaching an employment decision. In connection with this application, and in the future as deemed appropriate, I authorize the LVJUSD YouthBuild and/or agents to investigate all statements in this application and attachments to it, to interview individuals including, but not limited to: present and past employers, to review my driving record, criminal convictions, education, residence and character, etc. unless such information is restricted by law. I understand that only information which is pertinent to the position for which I have applied and, if hired, for my continued employment at LVJUSD YouthBuild will be considered. I authorize this document to serve as my authorization to any persons, companies, government agencies, educational institutions and any other entities to release them and LVJUSD YouthBuild from any liability. In the event I am hired by LVJUSD YouthBuild, I understand that employment is “at will” and that my employment may end with or without cause, and with or without notice at any time, at my, or LVJUSD YouthBuild’s option. I understand that any job offer is contingent upon successful completion of a background check and my application will immediately be rejected or, if employed, I will be immediately discharged for providing false information in the application or omitting material information requested. I further understand and agree to submit to pre-employment fingerprinting if requested by LVJUSD YouthBuild. I understand and agree that any dispute, controversy or claim arising out of or relating to my application for employment, (employment or termination of employment) with LVJUSD YouthBuild shall be resolved by binding arbitration, pursuant to the rules and procedures of the American Arbitration Association and conducted in a private manner in Alameda County, California. All expenses of arbitration shall be borne equally by the parties, and all legal fees shall be borne by the party incurring said fees. I certify that I have reviewed and understand the above statement.

Sign & Date -- Please plan to sign and date your application during your interview.

Signature

Date

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