YCC_2015 Youth APP - Farmington Municipal Schools
2015 YOUTH WORKER NEW MEXICO YOUTH CONSERVATION CORPS SUMMER APPLICATION NAME: ___________________________________________________________________________________ HOME ADDRESS: ________________________________________________________________________ CITY, STATE, ZIP: ________________________________________________________________________ DATE OF BIRTH:_________________________________________________________________________ CONTACT NUMBERS _____________________________home/________________________________cell PARENT/GUARDIAN NAME: ______________________________________________________________ WHAT SCHOOL DO YOU PRESENTLY ATTEND? __________________________________________ TEACHER FOR RECOMMENDATION:_____________________________________________________ HAVE YOU BEEN A CURRENT RESIDENT OF NEW MEXICO FOR AT LEAST THE PAST 6 MONTHS? YES NO ARE YOU BETWEEN THE AGES OF 14-19 as of 6/01/15? YES NO ARE YOU ABLE TO BEGIN WORK ON 6/01/15? YES NO ARE YOU ABLE TO WORK FROM 7:00 am-4:00 pm, M-F? YES NO Are you able to possibly work from 7:00 am -5:30 pm M-Th YES NO DO YOU HAVE RELIABLE TRANSPORTATION TO AND FROM JOB SITES? (Job site 7:00am to 12:00 noon, YES NO and Rocinante High School 1:00pm to 4:00pm.) THE YOUTH CONSERVATION CORPS IS AN EQUAL OPPORTUNITY EMPLOYER *This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the completion of this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of race, gender, marital status, age, creed, national origin, or the presence of a disability. Any conviction will not necessarily bar an applicant from employment. Individual testing for job-related skill and the presence of drugs in your body may be required prior to employment. After an offer of employment and prior to reporting to work, you may be required to submit to a medical review including completion of a medical case history and an examination by a medical professional designated by the district. All applicants for employment will have a background check review. 1 2015 YOUTH WORKER NEW MEXICO YOUTH CONSERVATION CORPS SUMMER YOUTH APPLICATION Please write a statement explaining why you feel you would be an asset to the Youth Conservation Corp team. (Please include a “willingness to participate” statement, your personal and professional goals, any previous experience participating in a team environment, any personal qualities and/or qualifications that would contribute to the YCC effort, and any other information you feel would be appropriate. Attach an additional page if more space is needed.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ___________________________________________________________________________________ List two adult references. (Do not list relatives.) Name_______________________________ Name_______________________________ Address_____________________________ Address_____________________________ City_____________________State_______ City_____________________State_______ Phone (____)____________Zip__________ Phone (____)____________Zip__________ Relationship_________________________ Relationship_________________________ 2 2015 YOUTH WORKER NEW MEXICO YOUTH CONSERVATION CORPS SUMMER APPLICATION I understand that the New Mexico Youth Conservation Corps summer program is a work/educational program designed to accomplish needed conservation work on public lands and is also designed to provide a unique environmental learning experience. I hereby certify that all statements made in this application are true and correct. This application will not be processed without the appropriate signatures. Only hard copy applications will be accepted. Please, do not email your applications. Applicant’s Signature____________________________________Date_____________________ Parent’s/Guardian’s Signature_____________________________Date_____________________ Parent’s/Guardian’s Signature_____________________________Date_____________________ Application Deadline: April 10, 2015 Drop Off/Mail/Email Application To: Farmington Municipal Schools ATTN: Rocky Torres - NMYCC Summer Program 2200 Sunset Ave Farmington, NM 87401 [email protected] Interview Schedule: Applications will be reviewed, and due to the large number of applicants, only selected applicants will be contacted for an interview. You will be contacted after April 10th via email, so be sure to check your email regularly. Interviews will take place April 15th 1:00-8:00 pm, and April 16th and 17th 4:00pm-8:00 pm. _________________________________________________________________________________________ _________________________________________________________________________________________ Please write down any Vacation/Time off you will need to take during June 1- August 1, 2015. _____________________________________________________________________ _____________________________________________________________________ **VERY IMPORTANT** YOU will need to get a TEACHER RECOMMENDATION. Ask the teacher you select to complete the recommendation found on the page attached and return in a sealed envelope to you. Teacher Recommendations must be turned in with your application. Teacher’s Name, School & Contact Information___________________________________ 3 2015 Youth Worker New Mexico Youth Conservation Corps Teacher Reference Please complete the recommendation and return to the student in a sealed envelope. This recommendation will be turned in with their application. Rocky Torres 2200 Sunset Ave. Farmington, NM 87401. Teacher’s Name___________________________________________ Student’s Name____________________________________________ School______________________________________________________ Why do you recommend this student? ______________________________________________________________________________ ______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ ________________________________________________________________________________ Compared to other high school/middle school students, how do you rate this student in terms of the following qualities: Below Average Good Very Good Excellent Average Motivation Self Confidence Disciplined Work Habits Leadership Abilities Attendance 4
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