Student Enrollment Form

Please fill out the following fields for the Job Match and Employment Skills Programs.
* Required fields


* Is this your first registration with us,
or are you Registering again?:
New Registration Re-Registration
* Name:
* Grade:
* Homeroom:
Address:
  
City:
Zip code:
County:
* School:
* Phone Number:
* Email:
Date of Birth:
Age:
Gender:
Male Female
* Please choose the order of preference for job types you are interested in:

 

Choice # 1:
Choice # 2:
Choice # 3:
Choice # 4:
Choice # 5:
If you checked other, please explain:
Please mark the days and hours you are available to work:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
Do you have any special certifications or training that would be applicable to your job?
Do you have a driver's licence?
Do you have transportation available to you?
What are your current or anticipated after school activities?
Please list any previous work and volunteer experience, including length and dates of employment:
Do you have any special skills or hobbies?
How did you hear about CHS' Youth Employment Services?


Program funding sources require CHS to collect demographic information about familes served. Please help us by providing the following information. Your cooperation helps CHS secure the resources needed to operate our programs.

Total number of people in your household:

Estimated Annual Household Income -
Please check one:

Less than $25,000

$25,000 - $34,000

$35,000 - $49,000

$50,000 - $74,000

$75,000 - $99,000

$100,000 - $149,000

$150,000 or more

Please verify the code below:
Youth Employment Enrollment Form