Docstoc

Summer Night Lights Youth Squad Summer Internship Program Application

Document Sample
Summer Night Lights Youth Squad Summer Internship Program Application Powered By Docstoc
					Summer Night Lights (SNL), in partnership with Long Beach Parks Recreation & Marine, Long Beach Police
Department, and non-profit community based organizations, offers safe and healthy alternatives to crime and
delinquency at night during the peak hours for gang activity with free food and expanded programming.

By empowering communities and targeting the traditionally most-violent summer months, Summer Night Lights has
become a national model for violence reduction
      Summer Night Lights is a 9-week program and will run from July 2 – August 31, Monday through Friday, from 6 – 9 p.m.
      Summer Night Lights Program will be offered at Admiral Kidd Park, Drake Park, and Martin Luther King Park.
      Program activities include but are not limited to: sport tournaments, art projects, youth leadership programs, talent
       contests, cultural art dances, parent empowerment classes, counseling services, and an end of the summer celebration.
      Free nutritional Dinners will be served each night for program participants



      30 youth will be recruited to complete internship hours at one of three SNL park sites
      Youth Squad will be expected to help organize daily park activities including set-up, maintenance, prepare
       and serve meals, track participants, and participate in program activities.
      Must maintain a professional attitude
      Duties may require lifting boxes weighing 25 pounds or more or standing for long periods of time
      Youth Squad are required to attend daily staff meetings that will include assignment of specific tasks; and
       are responsible for reporting to assigned Outreach Worker Supervisor


      Live in the surrounding SNL park site neighborhoods. (Admiral Kidd Park, Drake Park, Martin Luther King Jr. Park)
      Must be between the ages of 16-18
      Proof of recent TB test within the past year is required. Youth will not be allowed to work without proof of
       a negative TB test or proof of chest X-ray exam
      Demonstrate the willingness to work
      Must be available to attend and participate in required trainings provided by the Advancement
       Project’s “Urban Peace Academy” through the period between June 18, 2011 and June 29, 2011


Friday, April 20 (no later than 5 pm)


           Deliver your completed applications along with the required documents attached to your application to:
                           Centro C.H.A., Inc., 1900 Atlantic Avenue, 2nd Floor Long Beach, CA 90806
                 For further questions please contact Francisco Martinez, Youth Coordinator at (562) 570-4722
 *We Reserve the Right to Change the Terms of this Application upon Funding Availability*
Page | 1
                         Summer Night Lights 2011
                   Youth Squad Summer Internship Program

                                 Document Check List

                   Must have all documents to determine eligibility

    Must show proof of CA I.D./Driver License/School ID
    Proof of recent TB test within the past year is required. Youth will not be
allowed to work without proof of a negative TB test or proof of chest X-ray exam

     Social Security Card
     Proof of residency (Utility bill: gas, electricity, or water)
     High School Transcripts




Page | 2
                                                 Long Beach Summer Night Lights 2011
                                          Youth Squad Summer Internship Program Application


                                                             Applicant Information
 Thank you for your interest in applying to be in the Long Beach Summer Night Lights Youth Squad Summer Internship Program. Please complete
 this application form in ink and write legibly. The information requested is to assist in determining your eligibility to participate as a Youth Squad
 Member and will remain confidential. If you have any questions, please refer to the application fact sheet on the first page or call (562) 570-4722

Full Name:                                                                                                              Date:
                 Last                                         First                                     M.I.
Address:
               Street Address                                                                           Apartment/Unit #

               City                                                                                     State                           ZIP Code
Phone:     (          )                                                 E-mail Address:

Date of Birth:            /         /     Social Security No.:                                    Current Age:

Position Applied for: Youth Squad
Have you ever worked for this   YES NO
organization?                                                         If so, when?
                                                     YES              NO
Are you currently on probation?                                             If so, is it Juvenile or Adult ?(please specify) _______________

If yes, explain your terms of probation:
If on probation, what kind is it?             Formal                  In-Formal
                              YES       NO
Are you on parole?

What is the name address and phone number of your Probation or Parole officer?

(Name)____________________________ Address & Phone # _____________________________________

                                                                        Education

High School:                                                   Address:
                                                                                  YES     NO
From:                         To:                 Did you graduate?                               Degree:

                                                       Professional/Academic References
Please list one reference.

Full Name:                                                                  Relationship:

Address:                                                                                          Phone:        (           )


                                                              EMERGENCY CONTACT
 Please list two emergency contact .

 Full Name:                                                                       Relationship:

 Address:                                                                                             Phone:            (           )

 Full Name:                                                                       Relationship:

 Address:                                                                                           Phone:          (           )
Page | 3
                                                    Previous Employment



Company:                                                                     Phone:    (       )

Address:                                                                         Supervisor:

Job Title:                                         Starting Salary:      $                     Ending Salary:   $

Responsibilities:

From:                     To:                    Reason for Leaving:
                                                                   YES        NO
May we contact your previous supervisor for a reference?


Company:                                                                     Phone:    (       )

Address:                                                                         Supervisor:

Job Title:                                         Starting Salary:      $                     Ending Salary:   $

Responsibilities:

From:                     To:                    Reason for Leaving:
                                                                   YES        NO
May we contact your previous supervisor for a reference?



Company:                                                                     Phone:    (       )

Address:                                                                         Supervisor:

Job Title:                                         Starting Salary:      $                     Ending Salary:   $

Responsibilities:

From:                     To:                    Reason for Leaving:
                                                                   YES        NO
May we contact your previous supervisor for a reference?




                                                      Availability
                                                                                                   YES   NO
Will you be enrolled in school any time between June 18 and August 31?
                                                                                                   YES   NO
Are you able to work flexible hours, nights and weekends?

Please list any prior commitments in the table below (please write specific times of unavailability):

    MONDAY            TUESDAY          WEDNESDAY          THURSDAY              FRIDAY              SATURDAY        SUNDAY




Page | 4
                                                     Additional Information

Do you have reliable transportation to                  YES     NO
and from work?                                                        Please explain:

If hired, would you be able to present evidence of your U.S. citizenship or             YES      NO
proof of your legal right to work in the United States?

Do you have any medical condition(s) that you believe would prevent you                 YES      NO
from participating in any aspect of this program?

If Yes, please explain:

Please list any languages spoken other than English:

Please list any extracurricular activities you are
currently involved in or have been in the past:



Please list any volunteer experience:




Based on the map below, rank the park sites you prefer to work at from 1-3 (1 being the region you prefer the most and 3
being the region you prefer the least).
A) Admiral Kidd Park ____           B) Drake Park____                  C) Martin Luther King Jr. Park____



                                                                                                 Admiral Kidd Park




                                                                                                  Martin Luther King Jr. Park




                                                                                                  Drake Park




Page | 5
                                                         Demographics


We do not discriminate against qualified applicants based upon any protected group status, including but not limited to race,
color, creed, religion, sex (except where it is a bona fide occupational qualification), national origin, ancestry, age, marital
status, military or veteran status, sexual orientation, physical or mental disability or medical condition as defined by applicable
equal opportunity laws.

To help us comply with federal/state equal opportunity record keeping, reporting and other legal requirements, we would
appreciate you voluntarily providing the information below.

Gender:         Male           Female

Ethnic Group (check all that apply):
            White or Caucasian          African American or Black         Hispanic or Latino         Asian
            Pacific Islander or Native Hawaiian          Native American Indian or Alaska Native
            Two or more race (please specify):_______________________

Please check all that apply:
    Foster Youth         Pregnant and/or Parenting          At risk of Dropping out of School        Homeless          Offender
    High School Drop-Out           Limited English        Disabled        Runaway Youth
    Have Been/In Substance Abuse Program


Please indicate which SNL program activities you are most interested in participating in:
    Sports/Tournaments           Youth Leadership Development            Education         Peer Counseling
    Serve meals          End of summer celebration /Contests/Special events            Cultural Dancing        Arts
    Other:____________________________________________________________________________________________


                                                   Disclaimer and Signature


I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or
interview may result in my release.

Youth Signature:                                                                                Date:

Parent /Guardian First & Last Name (Print):                                                     Date:

Parent/Guardian Signature:                                                                      Date:




Page | 6

				
DOCUMENT INFO