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Last, First, Middle Initial
Street Number and Name, Apartment Number (if applicable)
Please list your areas of highest proficiency, special skills, or other abilities that may contribute to your abilities as a participant in the Youth Employment Program.
I certify that the information on this application and its attachments is true and correct to the best of my knowledge and that there is no intent on my part to defraud. I authorize inquires as to the validity of this information. The data may be distributed to employers and social services agencies for the purpose of obtaining training and/or employment. I understand that providing false information on this application and its attachments can result in my being declared ineligible for participation or terminated, if already enrolled, and I may be subject to prosecution under the law. I further certify that I fully understand the foregoing.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Signature for waiver will be required if participant is accepted into the Youth Employment Program.
This field is not part of the form submission.
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