Statesville NC 28677wwwyipeyouthcom7047754360PREVIOUS EMPLOYMENTVOLUNTEER EXPERIENCECompanyPhoneYIPE PROGRAM Enrollment FormAPPLICANT INFORMATIONLast NameFirstMIDate ofBirthStreet AddressApartment ID: 868742
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1 104 S. Center St., Ste. 102 Statesvi
104 S. Center St., Ste. 102 Statesville, NC 28677 www.yipeyouth.com 704 - 775 - 4360 PREVIOUS EMPLOYMENT /VOLUNTEER EXPERIENC E Company Phone YIPE PROGRAM Enrollment Form APPLICANT INFORMATIO N Last Name First M.I. Date of Birth Street Address Apartment/Unit # City State NC ZIP Cell E - mail Address Gender Race Age Shirt Size Shoe Size How did you hear about YIPE? Do you have access to internet? YES NO Where? Do you play video games? YES NO Are you currently a student? YES NO If yes, where? Have you ever been convicted of a felony? YES NO If yes, explain EDUCATION High School Address From To Did you graduate? YES NO Diploma/ ? Middle School Address From To Did you graduate? YES NO Certificate REFERENCES Please list three community references. Full Name Relat
2 ionship Company Phone Addres
ionship Company Phone Address Full Name Relationship Company Phone Address Full Name Relationship Company Phone Address Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for L eaving May we contact your previous supervisor for a reference? YES NO Company Phone Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for L eaving May we contact your previous supervisor for a reference? YES NO PARENTAL INFO Name: Phone: Street Address: City: State: ZIP CODE: Where do you see yourself in five years? Please use this space to write a summary of the next five years of your life by explaining in the best way you know how where you plan to go an
3 d the path you plan to take. Please in
d the path you plan to take. Please include t he people who you think will be supportive in this journey with you. Type Here: Do you enjoy work ing with others? YES NO E xplain Do you enjoy working alone? YES NO Explain. * Have you ever dreamed of an ideal job? YES NO If yes, where? Do you ever have trouble expressing yourself to others? YES NO If yes, e xplain Are you afraid to speak in front of a group? YES NO Explain * If you could work ANYWHERE in Iredell County where would you work? And Why? DISCLAIMER AND SIGNA TURE I certify that my answers are true and complete to the best of my knowledge. I understand that YIPE in Iredell County, Inc. is not an employment agency and that it provide s soft skills and effective communication techniques to enhance the knowledge of you th between the ages of 14 – 21 years of age. Signature Date