Summer Youth Employment Program
● ● CLOSED ● ●
We are no longer accepting applications.

●   Important Instructions You MUST Read   ●

●   The Application will CLOSE at 5:00 P.M. on January 22, 2019.   ●

●   You can only apply ONE time.  ●

● OUR SLOTS ARE LIMITED. If you are selected to participate in program, CareerSource Broward (CSBD) will mail you an eligibility packet to your home address. It is your responsibility to enter the CORRECT ADDRESS to receive the packet in time.
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● A non-expired original government issued Photo ID and a Social Security Card are MANDATORY for all participants at their eligibility interview. (Copies of either will NOT be accepted). If you do not currently have a proper ID or Social Security Card, we recommend you request one at your local agency at this time. You WILL NOT be allowed to complete your eligibility process without these and any other requested documents. You are also required to personally appear for your Eligibility Interview if you are selected for the program, along with a parent or legal guardian if youth are under 18 years old.
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● Please complete all fields as accurately as possible. All statements made on the application will be reviewed and verified. False or misleading information may result in your application being rejected and/or can lead to termination from the summer Youth Employment Program.
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● Eligibility is limited to Broward County participants who are 16 to 18 on the day the program begins June 10, 2019.

Personal Information


Last Name: (Jr, Sr, III):
Social Security Number:  
Date of Birth:
Age you will be on 06/10/2019:
Your birthday must be between 06/11/2000 and 06/10/2003 (inclusive). A valid I.D. will be required.

Gender:  

Are you legally able to work in the U.S.?
If you are not a U.S. Citizen, you must provide proof of current eligibility to work in the U.S., i.e. Permanent Resident Card, Alien Registration Receipt (Form I-551), Employment Authorization (Form I-766, Form I-94 or I-94A). If you cannot provide any of the above, you will not be able to participate in the program.

Address/Contact Information

This is the address your eligibility packet will be mailed to if you are selected for the program.
Incomplete or inaccurate information will prevent your eligibility packet from reaching you and result in disqualification.

You must be a Broward County Resident!
Example Address: 7231 NW Sherman Circle Bldg C APT 104
No PO Box will be accepted.

  Apt/Bld Number:  (Example: BLD 102 APT 235)  

City:        
State:     Zip:    
Your Home Telephone Number: Digits only. Example: 9542023830  
Email Address:  
Verify Email Address:  
Your Cell Phone Number:

Parent or Guardian's Contact Information

Parent or Guardian's Name:  
Telephone Number:   Digits only. Example: 9542023830
Cell Phone:
Email Address:

Demographic Information

School Identification Number (Student ID#):  
School Name?  
What is your Grade point average in High School?  
In August 2019, in what grade will you be?  
Home Arrangement:  
Household Income:  
Race:  
Ethnicity:  
Country of Birth:  
Language Spoken at Home:  
Cultural Influence:  
     
   
   

Work Experience Information

Worksite assignment preference (City):  
How do you plan to get to your worksite?  
List any languages, other than English, that you speak:
What type of work experience would you prefer (1st Choice)?  
What type of work experience would you prefer (2nd Choice)?  
This will help us to match you to available jobs closely related to your preference. Please note there is no guarantee you will be placed in the exact preference you selected.

  Select all that apply to you. Doing so will help us to match you to work experience suitable to your unique needs and background.
  (We will ask for verification)












Have you been CONVICTED of ANY violation of the law, other than minor traffic offenses, or pleaded NOLO CONTENDERE to criminal charges, even if adjudication was withheld?  
 
 
 
 
NOTE: An arrest or conviction does not automatically disqualify you from participating in the work experience program. Some worksites are not allowed to employ individuals with certain offenses. Your information will make it easier for us to develop appropriate jobs and to be able to place you if you are selected.
  (It will be verified)
 
 
 
 
Please:  Click the Submit button only ONCE.
Make sure all your information is correct BEFORE you click Submit.
All information on this form is correct and accurate: ()

Submission of this Application does NOT guarantee that you will be contacted or offered a job.
● If the "Submit" button is not active or greyed out be sure you read the instructions at the top of the page! Ensure all check boxes are checked. ●


You will receive an ELIGIBILITY PACKET in the mail if you have been SELECTED to participate in the program.
If your address changes at any time, please call (954) 202-3830. Please check our website at www.CareerSourceBroward.com
Please DO NOT CALL to check if you were selected!!
Copyright © 2019 CareerSource Broward