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Mayor's Summer Youth Internship Program Application 2019

  1. Example: Rachel (Do not use all caps)

  2. Example: Smith (Do not use all caps)

  3. Example: 31 Spooner St.

  4. Only use if applicable, leave blank if not

  5. Example: 14215

  6. Example: Somalia

  7. Example: 716-555-1212

  8. Example: 716-555-1213

  9. Example: 716-555-1234

  10. Example on the Middle Left of your card: 335-049. DO NOT USE THE AT-18 AT THE TOP OF THE CARD

  11. Example: Somalian

  12. Please check all that apply to your household income*

  13. Please check any that apply to you

  14. Are you currently attending school?*

    As of 3/29/19

  15. Examples: School #81 or Burgard High School, or Niagara University. Use the Full Name of your school/program

  16. Check all that apply to your as of today

  17. Provide three (3) personal references: (1 Related and 2 Non-Related) ** THIS IS MANDATORY**

  18. Example: John Smith

  19. Example: 716-555-1212

  20. By checking this box you hereby certify that all of the information given on this application is correct to the best of your knowledge*

  21. By checking this box, I acknowledge that I understand I have to submit an employment eligibility verification form to be considered for employment *

  22. By checking this box, I acknowledge that I understand I have to submit proof of residence to be considered for employment *

  23. Leave This Blank:

  24. This field is not part of the form submission.