Wufoo

2010 Summer STEPS Application

Welcome to the Summer STEPS 2010 Job Application. Items marked with an asterisk ( * ) must be completed.

First Name *
Last Name *
Gender *
Age *
Date of Birth * MM / DD / YYYY
MUST BE BORN BETWEEN JUNE 21, 1988 AND JUNE 21, 1994.
Are you legally able to work in the United States? *
Yes No

MUST BE LEGALLY ABLE TO WORK IN THE U.S. IF YOU ARE NOT A US CITIZEN, YOU MUST PROVIDE A WORK VISA
Street Address *
Street Address - Line 2
City *
Postal / Zip Code *
Phone Number * ### - ### - ####
Alternate Phone Number ### - ### - ####
Email
Confirm Email
Parent or Guardian's Contact Information
Parent/Guardian's First Name
Parent/Guardian's Last Name
Parent/Guardian's Phone Number ### - ### - ####
Parent/Guardian's Email
Confirm Email
Demographic Information
Will you be attending school in August 2010? *
Yes No
If yes, what is the name of the school?
If yes, what grade will you be in?
Home Arrangement *
Household Income *
Race *
Language at Home *
Country of Birth *
Cultural Influence *
Primary Disability Diagnosis *

MUST HAVE ONE OF THE FOLLOWING DISABILITIES. DOCUMENTATION WILL BE REQUIRED.
Total Number of People Living in your Home
*
Are you available to work Monday - Friday? *
Yes No
Disability Documentation *
Organization Referred by:
Do Not Fill This Out