2024 Youth Worker Application

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Fields

Youth Work Job Application

Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Cell Phone

DOB (Date of Birth)

Gender

Male Female 3rd Gender Transgender Prefer to Self Identify

Race

Primary Parent/Guardian (If under 18 years old)

First Name

Last Name

Primary Parent/Guardian Cell Phone

Primary Parent/Guardian Email

If hired, can you provide proof you are eligible to work in the United States? (Birth certificate or social security card)

Yes No

Are you CURRENTLY a high school student? (2023-24 school year)

Yes No

What grade are you CURRENTLY in? (2023-24 school year)

9th Grade 10th Grade 11th Grade 12th Grade Post-High School

Have you worked for Summer Academy before?

Yes No

If yes, when?

Job Interest

Do you have reliable transportation to get to and from work?

Yes No

Summer Academy hours are Monday-Friday from 7:30am - 3:30pm. Are you able to work within this daily shift?

Yes No

List any dates that you are unable to work.

I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States.

Yes No

Employment History

Current or Previous Employer

City, State

Date of Hire

Position Held

Describe your job responsibilities

Supervisor's Name

First Name

Last Name

Supervisor Phone

Reason for leaving

Have you ever been arrested?

Yes No

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.

Have you ever been charged with a crime?

Yes No

If yes, please explain

Are other family members impacted by the criminal justice system?

Yes No

Do you live in a two or single parent household?

Two parents Single parents Other

Do you receive free or reduced lunch?

Yes No Unsure

Education Information

Name of High School

Expected Year of Graduation

You should hire me because....

Summer Academy Youth Worker Roles and Responsibilities

Adhere to policies and procedures of the 100 Black Men of Indianapolis, Inc.:

Report to Summer Academy Director for work at designated time dressed appropriately (see uniform policy) and on time for workday (7:30am-3:30pm)
Assist in areas where asked by either the Summer Academy Director, Assistant Director, Teacher, or Designee
Assist teacher with daily duties
Communicate any issues with another student to a teacher or the Summer Academy Director, Assistant Director, or Designee
Only assist with behavioral issues when asked by a teacher or Summer Academy Director, Assistant Director, or Designee
Youth Worker is accountable to the same uniform policy of the students
Youth Worker is expected to address any concerns he/she has with the Summer Academy Director and then the Chair (if needed)
Assist with directing, guiding, and overseeing students while in attendance on field trips, special events, playground, classroom, and gymnasium
Assist with Morning Assembly and dismissal if Youth Worker hours cover those two functions
Assist with morning breakfast and afternoon lunches if Youth Worker hours cover those functions

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