Summer Jobs Program

Application Instructions

We have 10 criteria in our summer jobs application that requires a youth to submit some type of documentation to be eligible for the program. Age – Date of Birth

Citizenship Residency Income Selective Service Compliance Barrier Work Permits Tax Forms Bank Account Personal Statement

Program Criteria

Age – Date of Birth

2015 YouthWorks Summer Jobs ProgramAcceptable Forms of Documentation

ONE document from each of the following criteria is required for enrollment.

Basic Eligibility Criteria Acceptable Sources of Documentation *(please see staff for other acceptable

sources)1. Age/Birth Date Birth Certificate

Driver’s License/Mass ID Card

Passport School Record

Citizenship

2015 YouthWorks Summer Jobs ProgramAcceptable Forms of Documentation

ONE document from each of the following criteria is required for enrollment.

Basic Eligibility Criteria

Acceptable Sources of Documentation *(please see staff for other acceptable sources)

2. Citizenship/Authorization to work in the USA

U.S. Birth Certificate U.S. Passport

Unexpired Alien Registration Card

Residency

2015 YouthWorks Summer Jobs ProgramAcceptable Forms of Documentation

ONE document from each of the following criteria is required for enrollment.

Basic Eligibility Criteria

Acceptable Sources of Documentation *(please see staff for other acceptable sources)

3. Brockton Residents

LicenseState I.D.Utility Bill w/ name & address

School record School I.DLease with your name on itPay Stub

Income

4. Income - You must be determined low income by the 2015 federal poverty guidelines. YouthWorks Staff will determine income levels. Use the info below as a guide.

Proof of Free Lunch School Letter Cash Public Assistance/Food Stamps Copy of Current Authorization to

Receive: Cash Assistance/Food Stamps

Individual/Family Pay Stubs(3 weekly or 2 bi-

weekly) Bank Statements (Direct

Deposits) Housing Authority Verification Social Security Benefit Applicant Statement - must be

supported with a corroborative contact or reliable witness(ask YOUTHWORKS staff for applicant statement form)

Homeless – Customer’s own income must be considered. Written Statement from a the

PERSON Providing Temporary Residence

Written Statement from Shelter/Social Service Agency

Letter from Commonwealth of Massachusetts EOHHS Agency (for Foster Child and State Custody Youth, only)

State Custody Youth – Customer’s own income must be considered. Written Statement

from State\Local Agency

Letter from Commonwealth of Massachusetts EOHHS Agency

Court Document Medical Card Verification of

Payments made on Behalf of the Child

Supported Foster Child – Income verification not required. Court Document Verification of

Payments made on Behalf of the Child

Written Statement from State\Local Agency Letter from Commonwealth of Massachusetts EOHHS Agency

Family Size

Annual Income

1$23,540

2$31,860

3$40,180

4$48,500

5 $56,820

6$65,140

Each additional family member +$8,320. Example: Fam. Size 7: 63,940.00+8,320.00=72,260.00

Selective Service Compliance

2015 YouthWorks Summer Jobs ProgramAcceptable Forms of Documentation

ONE document from each of the following criteria is required for enrollment.

Basic Eligibility Criteria

Acceptable Sources of Documentation *(please see staff for other acceptable sources)

5. Selective Service Registrants (18+ Males)

Selective Service Online Verification at:http://www.sss.gov (printout) Selective Service Registration Acknowledgement Card

Barriers

6. Barriers (Only ONE of the following is required)

Acceptable Sources of Documentation

If you do not have access to the documents listed below please speak with the YOUTHWORKS staff for other approved items.

1. School Dropout Dropout Letter Attendance Letter from school

2. Poor Academics – D’s & F’s School Record/document TABE

3. Child Living in Single Parent Household

Lease/Landlord Housing Authority Doc. Recent Tax Return.

4. Disability, Learning Disability

School Records Doctor’s Note Medical Records

5. English as a 2nd language School Record Assessment given by BAWIB Staff TABE

6. Foster Child See acceptable income documents above

7. Homelessness or Runaway See acceptable income documents above

8. Pregnant or Parenting Birth Certificate Doctor’s Note

9. Court Involved – DYS, Juvi, CHINS, etc.

Court Document PO Letter See Above

10. None None of the above barriers apply

Work Permits

2015 YouthWorks Summer Jobs ProgramAcceptable Forms of Documentation

ONE document from each of the following criteria is required for enrollment.

Basic Eligibility Criteria

Acceptable Sources of Documentation

7. Mass Work Permit - Required for all youth 16-17

Provide parent and youth signatures on permit application and bring to school department to get permit. See pg. 5-6

Tax Forms

2015 YouthWorks Summer Jobs ProgramAcceptable Forms of Documentation

ONE document from each of the following criteria is required for enrollment.

Basic Eligibility Criteria

Acceptable Sources of Documentation

8. Tax Forms - W4 & I9

Fill out forms & provide require documents. See pg. 8-10

Bank Account

2015 YouthWorks Summer Jobs ProgramAcceptable Forms of Documentation

ONE document from each of the following criteria is required for enrollment.

Basic Eligibility Criteria

Acceptable Sources of Documentation *(please see staff for other acceptable sources)

9. Bank Account Information

Open account and ask bank for direct deposit form If you have an account ask bank for direct deposit authorization form

Personal Statement

*NEW REQUIREMENT*Basic Eligibility

CriteriaAcceptable Sources of Documentation

10. Personal Statement

Please submit a 400-500 word personal statement see pg. 3 for details

THANK YOU FOR YOUR TIME AND

INTEREST