Youth Employment Application for Ages 16 and 17

Legal Name *

Preferred Name

Date of Birth (mm/dd/yyyy) *

work Number Permission

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Are you attending school? *

If yes, name of school and city/town

Position applying for (you can check more than one)

Days you are available to work (check all that apply)

Hours you are typically available to work?

Earliest date you could be available to work?

Previous Work Experience

Please list employer, type of work, primary duties, and dates of employment for any other jobs you have held.

Emergency Contact Name: *

Emergency Contact's relationship to you?

Emergency Contact Phone Number *

Parental Permission Required *

I acknowledge that I must present the supplied permission form signed by a parent or legal guardian before I can work.

State of NH Department of Labor Parental Permission - Youth Age 16 or 17 Form must be completed and turned in to begin employment.

Certification *

I certify that information provided is true and correct and I am willingly seeking employment.

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409 Beech Street, Manchester, NH 03103
603-626-0211
info@manchesterpoliceathleticleague.org