Youth Employment Services Enrollment Form
Job Match and Employment Skills Programs
New Registration _____ Re-Registration _____
Name _________________________________ Grade _____ Homeroom
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Address _____________________________ City______________ Zip
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County ________________________________ School
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Telephone ________________________ E-mail
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Date of Birth _______________________ Age _________ ___Male
___Female
Please number from 1-5, in order of preference, which types of jobs you are
interested in:
Child Care Retail Office Work
Yard Work Restaurant Housework/ Cleaning
Carpentry Pet Care Life Guard
Elder Care Stock Work Other
If you checked other, please explain
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