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