Junior Apprenticeship Application

Junior Apprenticeship Application

Student Contact Information

This will be the method used to contact you if selected.

Full Name*

Address*

City*

State*

Zip*

Primary Email*

Secondary Email*

Primary Phone#*

Phone

Secondary Phone#*

Phone

Shirt Size*

Select

Shirt Fit:*

Men's

Women's

Parent/Legal Guardian Contact Information

Parent/Legal Guardian Full Name*

Parent/Legal Guardian Primary Email*

Parent/Legal Guardian Secondary Email*

Parent/Legal Guardian Primary Phone Number*

Phone

Parent/Legal Guardian Secondary Phone Number*

Phone

Junior Apprenticeship Position

Which semester are you applying for (select one)?*

Fall

Spring

Both

Which Junior Apprenticeship positions would you like to apply for? (Students may apply for one or two different positions.)

Position One*

Select

Position Two

Select

How did you hear about the program?

Any other ways you heard about the program?

What is your date of birth?*

Are you a U.S. Citizen?*

YES

If “NO” do you possess an I-151, I-1551, or an I-94 card stamped Employment Authorized?”

Yes

After School Activities

YES

If “YES” please list them and the dates/times they occur.

Work Schedule and Transportation

How will you travel from school to your County worksite?

Select or enter value

Please select your preferred work schedule:

Schedule Option A: Monday-Friday, 2:00pm-5:00pm, Total: 15 hrs/week

Schedule Option B: Monday-Friday, 2:30pm-5:00pm, Total: 12.5 hrs/week

Schedule Option C: Monday-Friday, 3:00pm-5:00pm, Total: 10 hrs/week

Schedule Option D (For students dual enrolled at Lively Technical College): Friday, 1:00pm-5:00pm, Total: 4 hrs/week

Education and Training

High School

School Name

GPA

Last Grade Completed

Select

Previously Completed CTE Programs/Related Coursework

Guidance Counselor Information

A copy of your Junior Apprentice Application will be emailed to your guidance counselor for approval. Your guidance counselor must review and verify that you meet all eligibility requirements for the Leon Works Junior Apprenticeship Program. Also, your guidance counselor must verify that you are able to take the Junior Apprenticeship as your last class period for the semester (Students dual enrolled at Lively Technical College are permitted to take the Junior Apprenticeship as their last period class on Fridays from 1 to 5 pm).

Guidance Counselor Full Name*

Guidance Counselor Phone Number*

Phone

Guidance Counselor Email*

This email address will be sent your application for review of eligibility requirements

Dual Enrollment

School Name

GPA

Previously Completed CTE Programs/Related Coursework at Dual Enrollment School

Will you be enrolled in a Career and Technical Education (CTE) program or related course during the semester?*

YES

If “YES,” please list each CTE program or courses you will be taking that are related to the Junior Apprenticeship position you are applying for.

Work Record

Most Recent Employment History

Job Title

Employer

City

State

Supervisor's Name

Begin Date

End Date

Hours per week

Job Duties

Next Employment History

Job Title

Employer

City

State

Supervisor's Name

Begin Date

End Date

Hours per week

Job Duties

Next Employment History

Job Title

Employer

City

State

Supervisor's Name

Begin Date

End Date

Hours per week

Job Duties

Essay Section

In the space below, please explain why you would like to participate in the Leon Works Junior Apprentice Program. Discuss how the opportunity will help you pursue your career goals.

Begin writing essay here.*

CERTIFICATE OF APPLICANT

I hereby certify that all statements made in this application and any attachments to it are true. I understand that any misstatement, misrepresentation, or omission of fact may cause my application not to be considered; or, if I am employed, may cause my immediate dismissal. I authorize the Human Resources Division of Leon County to verify information contained in this application and attachments. I further authorize anyone having such information to release it. I understand that if I am selected for this position, and I am 18 years or older, prior to employment, a criminal history screening of my background may be conducted. *Additionally, I understand, certain positions within the Office of Information and Technology will be subject to higher level criminal history screening regardless of my age. I also understand and acknowledge that I am applying for a temporary position in the Leon Works Junior Apprenticeship Program.

Signature*

Please type your full name

Signature Date*

Send me a copy of my responses

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