New York Youth Jobs Program - Youth Certification

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New York Youth Eligibility and Participation
Youth Certification

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New York Youth Jobs Program - Youth Certification

* Indicates required fields

Questions? Need assistance? Call (877) 226-5724 or Email

First Name:

M.I.:

Last Name:

Date of Birth (MM/DD/YYYY):

SSN:

I am enrolled in High School:

Yes

Home Address:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Email Address:

Confirm E-mail Address:

Cell Phone Number:

Home Phone Number:

I am currently unemployed, I was unemployed prior to completing this application or I do not have enough paid work or work that is adequate with respect to my skills and training

Yes

I am 16 to 17 years old.

Parent/Guardian First Name:

Parent/Guardian Last Name:

Parent/Guardian Phone Number:

I am currently attending high school, enrolled in a High School Equivalency (HSE) program, or have obtained a high school diploma.

Yes

I have working papers.

Yes

Need assistance getting working papers?

I am 18 to 24 years old.

I have a high school diploma, a GED or HSE diploma, satisfactorily completed a TASC exam, or I am enrolled in a TASC program.

Yes

Program QualificationsI confirm that I currently meet one or more of the youth categories listed below.

I am over 18 and do not have a high school diploma or a GED/TASC/HSE diploma.
I am a member of a family that is receiving assistance from TANF.
I am a member of a family that is receiving SNAP benefits (food stamps).
I am a member of a family that is receiving SSI benefits.
I am receiving a free or reduced-cost school lunch.
I was referred here by a rehabilitation agency approved by the state, or an employment network under the Ticket to Work Program.
I have served in jail or prison - or am on probation or parole.
I am pregnant or a parent.
I am homeless.
I am currently or was in foster care or the custody of the Office of Children and Family Services.
I am a veteran.
I am the daughter or son of a parent who is currently in jail or prison, or has been within in the past two years.
I am the daughter or son of a parent who is collecting unemployment insurance.
I live in public housing or receive housing assistance such as a Section 8 voucher.
Another risk factor not identified above

Agreement

I have provided my private information on this application. While I need to disclose this information to qualify for the program, I understand that I do not need to explain the reasons I choose to anyone I ask for a job, who gives me a job, or who I work with.
I agree to allow the New York State Department of Taxation and Finance to share my wage records with the New York State Department of Labor.
I understand that the New York State Department of Labor will make sure the information submitted in this application is true and may ask me for details. I believe this information is correct and complete. I am aware that there are consequences for filing false documents or other information with the government

When I check this box and submit this form, I agree to the statement above.

Department of Labor

New York Youth Jobs Program - Youth Certification

Agreement