2. Directions: Please complete the application below in full. If you are helping an applicant complete this form all of the information entered below should be about the applicant. The electronic signature must be the applicant’s and it represents they attest to the information and intention to apply.
4. NOTE: The name on your application must match the name listed on your Social Security Card. Your original Social Security card will be REQUIRED upon hire.
6. APPLICANT'S PERSONAL INFORMATION: (REQUIRED)
8. Last Name:*
9. First Name:*
10. Middle:
12. Street Address:*
14. City:*
15. State: *
16. Zip:*
18. Cell Phone #:*
19. Home Phone #:*
21. Email Address:*
23. Birth Date:*
    Birth Date:
24. T-shirt Size*
    -- Select One --SMLXL2XL
28. EDUCATION: (REQUIRED)
30. Check Highest Grade Completed:*

    1. 8
    2. 9
    3. 10
    4. 11
    5. 12
    6. College
32. School Name:*
34. City/State:*
36. Graduated:*

    1. Yes

    1. No
40. MOST RECENT EMPLOYMENT/VOLUNTEER EXPERIENCE: (REQUIRED – Type N/A if you do not have prior experience)
42. Company:*
43. Duration:
    Duration: Start Date

    —

    Duration: End Date
45. Title:*
47. Job Duties:*
51. EMERGENCY CONTACT INFORMATION: (REQUIRED)
53. Parent/Guardian #1
55. First Name
56. Last Name
58. Address1
60. Emergency Contact Phone Number
61. Relationship to Applicant
63. Email
67. Parent/Guardian #2
69. First Name
70. Last Name
72. Address1
74. Emergency Contact Phone Number
75. Relationship to Applicant
77. Email
81. ADDITIONAL QUESTIONS FOR MAYOR’S SUMMER WORK EXPERIENCE: (REQUIRED)
83. 1. Are you a resident of Shelby County?*

    1. Yes

    1. No
85. 2. Are you between the ages of 18-24 by June 3, 2024 and will not reach age 25 before July 31, 2024?*

    1. Yes

    1. No
87. 3. Are you available to work EVERY WEEK DAY from June 3, 2024 through July 31, 2024?*

    1. Yes

    1. No
89. 4. Are you available to work during the hours of 8 a.m. and 4:30 p.m.?*

    1. Yes

    1. No
91. 5. Mandatory: What is your area of career interest or college major? List 3 areas of interest.*
93. 6. OPTIONAL: Is there anything else you’d like to share with the Mayor’s Summer Work Experience staff?
99. Signature (Type name to electronically sign):*
100. Date:*
     Date:
102. Disclaimer
     This position is subject to a background check for any convictions that have a substantial relationship to potential job duties. Only convictions that are substantially related to potential job duties will be considered and will not automatically disqualify the candidate.
Leave This Blank:


104. 1. Receive an email copy of this form.
105. Email address

     This field is not part of the form submission.

106. Submit Submit and Print

* indicates a required field