If you have any questions concerning this registration form or general questions about the Summer Youth Works Program, please contact Kesla Holder at
478-277-1404 or email 
Gender *
Primary Language *
Are you at least 16 years of age, or will be 16 by June 6, 2021? *
Do you have reliable transportation? *
Do you have any scheduled vacation plans this summer? *
Please read the below statements and sign off that they have been reviewed and agreed upon. *
Do you have a criminal history? Having a criminal history does not disqualify you. *
If yes, select one of the following:
Do you have a valid drivers license or state ID? *
Are you willing to participate in an initial drug screening? *
**If selected, we can not guarantee that you will be placed in your desired work interest.  We will make every effort to place you in a comparable position.