Cumberland County Summer Youth Employment Program ...

Cumberland County Summer Youth Employment ProgramApplication Distribution Summary SheetBASIC SUMMER YOUTH PROGRAM INFORMATIONPROGRAM DESCRIPTION: The Cumberland County Summer Youth Employment Program(SYEP) will combine a one week work readiness training component with seven weeks of workexperience. Youth must participate in both components of the summer program.PROGRAM DURATION: The Work Readiness training component will begin on June 29 thand end on July 2 nd . The Work Experience component will be seven (7) weeks in lengthbeginning on July 6 th and ending on August 21 st .HOURS/PAY: Youth will receive a stipend ($4.00 per hour) for participation in the workreadiness component. Youth who successfully complete work readiness will receive aperformance bonus of $25. Youth will receive minimum wage ($7.25/hour). They will workbetween 20 and 40 hours per week. Their summer work assignment will last seven (7) weeks.WORK ASSIGNMENTS: Youth will be assigned to approved worksites by the CumberlandCounty Office of Employment and Training. Generally, all youth work in an “aide” or“assistant” capacity under the direction of a worksite supervisor. Particular youth worksiteassignments will be based on travel considerations, skills needed to perform the job, childlabor law requirements, health and safety issues, and other similar parameters.HOW TO APPLYApplications will be available on or around April 1, 2009 at the following locations:Bridgeton High SchoolCumberland Regional High SchoolMillville High SchoolVineland High SchoolVineland Adult Education CenterBethel Development CorporationPathStoneTri-County CAPCumberland County CollegeCumberland County TECThe applications will be collected on a weekly basis.PROGRAM ELIGIBILITYBASIC SUMMER YOUTH ELIGIBILITY: Youth that participate in the program will be betweenthe ages of 16 to 24. Only youth who meet “economically disadvantaged” criteriaestablished by the US Department of Labor will be able to participate. The CumberlandCounty Office of Employment and Training will be responsible for recruiting the youth toparticipate in the program and for determining their eligibility based on those US Departmentof Labor standards. The NJ Department of Labor and Workforce Development has furtherdefined the target population as older youth ages 18-24 who are disengaged from educationand/or the workforce.

INCOME ELIGIBILITY: Family income will be reviewed to determine whether or not the youthmeet the “economically disadvantaged” criteria. The following is an outline of the earningsthat will count as family income and those that will not count as family income.Countable Income-Wages-Self-Employment-Workman’s Compensation-Pension Payments-AlimonyExcluded Income-Public Assistance-Unemployment Insurance-Social Security Disability-Social Security Retirement-Child SupportYouth will be required to provide documentation of all income regardless of whether it iscountable or excluded.OTHER ELIGIBILITY: Disadvantaged youth should also be in one or more of the following"employment barrier" categories:• Deficient in basic literacy skills;• School dropout;• Homeless, runaway or foster child;• Pregnant or parenting;• Offender; or• Requires additional assistance to complete an educational program or to secureand hold employment, as defined by the WIBADDITIONAL INFORMATION: If you need additional information or further clarificationabout the information presented in this summary, please contact:JACK SURRENCYPhone: 856-696-5660 ext 204Email: jsurrency@ccoel.orgCumberland County Office of Employment and TrainingP.O. Box 1398Bridgeton, NJ 08302-1398

CUMBERLAND COUNTY SUMMER YOUTH EMPLOYMENT PROGRAMAPPLICATIONPart I. Applicant Information (please print clearly and fill in all information)Name: _______________________________________ Last 4 Digits of SS#: _________________________Address: _______________________________________ Telephone Number: _________________________Apt #: __________________________________________ Alternate Number: __________________________City: __________________________________________ State: _____________ Zip Code _______________Date of Birth: ____________________________ Sex: □ Male □ Female Age: □ 16-17 □ 18-19□ 20-21 □ 22-24School Status: □ Attending High School Name of School: _______________Current Grade: __________(check one) □ High School Graduate/GED Graduation Date: ____________ Date GED Issued: __________□ High School Drop-out Drop-out Date: ___________Last Grade Completed: _________Transportation: How do you plan to get to and from work (check one)? □ Walk□ Bike□ Bus□ Parent/Relative Vehicle□ Own Vehicle□ Other (specify): __________How far are you willing to travel to work? (check one) □ Less than 1 mile □ 5 to 10 miles□ 1 to 5 miles □ More than 10 milesPart II. Work History (List 2 most recent jobs)Employer: ____________________________________ Job Title: _____________________________________Supervisor: ___________________________________ Phone: _______________________________________Start Date: ____________End Date: _______________ Reason for leaving: □ Fired □ QuitJob Duties ____________________________________ □ Seasonal □ Med/Health_____________________________________________□ Other: _________________Employer: ____________________________________ Job Title: _____________________________________Supervisor: ___________________________________ Phone: _______________________________________Start Date: ____________End Date: _______________ Reason for leaving: □ Fired □ QuitJob Duties ____________________________________ □ Seasonal □ Med/Health_____________________________________________□ Other: _________________Part III. Special Skills/QualificationsPlease indicate any special skills or qualifications that you have that may qualify you for one or more of ouremployment opportunities (check all that apply).□ Computer skills (Microsoft Word and Excel) □ Experience with lawn equipment□ Maintenance/Janitorial Experience□ Child Care Experience□ Clerical skills (Typing, filing, phone)□ Customer Service Skills□ Other skills (please specify):_________________________________________________________________Part IV. Placement PreferencesPlease indicate the type of work experience placement that you would prefer (check 3 choices):□ Office/Clerical Aide □ Recreation Worker Aide □ Food Service Worker Aide□ General Indoor Maintenance Aide □ Child Care Aide □ Community Aide□ General Outdoor Maintenance Aide □ Elderly Care Aide □ Education/Teacher’s AideCONTINUED ON OTHER SIDE – YOU MUST COMPLETE BOTH SIDES

Part V. Program Eligibility InformationMany jobs will require substance abuse testing and/or criminal background checks for placement. Failure to beable to pass these requirements will prohibit your ability to participate in the Summer Youth EmploymentProgram.(A) Family Size InformationFamily size is defined as the applicant plus all individuals who live in the applicant’s home and are relatedto the applicant by blood or marriage (examples are mother, father, sister, brother, grandparent, aunt, uncle,cousin, step-parent). If the applicant is between 18-21 years of age and supports his/herself without anyassistance from his/her family, then the applicant’s family size is one.Using the above definition, how many people, including yourself, are in your Family? ____________(B) Family Income Information1. Circle “Yes” or “No” in response to each of the following questions.Yes No Is the applicant a Foster Child?Yes No Does the applicant have a disability (including a Learning Disability)?Yes No Does the applicant or the applicant’s family receive County Welfare (TANF) orCity/Municipal Welfare? If Yes, what is your case number? ___________________Yes No Does the applicant or the applicant’s family receive Food Stamps?Yes No Does the applicant or the applicant’s family receive Free Lunch?2. Income Eligibility: Please provide the earnings for ALL FAMILY MEMBERS in your household thatearn income. List every family member and their source of income (i.e. job, TANF, SSI, UI, etc.).Name of family memberSource of income (job,TANF, etc.)Date incomebegan to bereceivedGross Income permonth (amt. earnedbefore taxes)Relationship toapplicantPart VI. Certification and Release of InformationI certify that the information provided on this application is true and to the best of my knowledge there is no intentto commit fraud. I am also aware that an eligibility determination made on the basis of the information presentedis subject to verification and applicants will be required to document its accuracy. Knowingly falsifying informationwill subject me to prosecution for fraud.I hereby give permission to the Office of Employment and Training and/or any partner agency to obtain copies ofthe applicant’s school records (including but not limited to attendance, grades, free lunch status, special educationstatus, etc.) that may be needed to verify eligibility, make selections for participation in the Youth Program, and torecord progress of participation in the Youth Program. I hereby give permission to the Office of Employment andTraining to verify income/benefits listed on this application by contacting employers or agencies from which theapplicant and/or the applicant’s family members receive income or benefits.___________________________________Signature of Applicant___________________________________Date__________________________________Signature of Parent or Guardian__________________________________Date