Parent or Guardian's Contact Information
Parent or Guardian's Name:
Digits only. Example: 9542023830
School Identification Number (Student ID#):
What is your Grade point average in High School?
In August 2019, in what grade will you be?
Country of Birth:
Language Spoken at Home:
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)
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!!