Personal Information

Last four digits of Social Security #
Birth Date*
Confirm Email*
State / Province*
Cell Phone #*
Text okay?*
  • YES
  • NO

Education Info

School you currently attend or last attended*
Last Grade Completed*
Educational Attainment*
  • AA Earned
  • AA In Progress
  • BA/BS Earned
  • BA/BS In Progress
  • GED Earned
  • GED In Progress
  • HS Diploma Earned
  • HS Diploma In Progress
  • None
If yes, how were you referred*

Living With

Guardian: Relationship to you?
Living Arrangement - Other

Financial Info

Financial Support - Other
Family Annual Income (if you are self-supporting, list your own personal annual income)*
Do you think you might have any additional challenges that might make it difficult to find a job?
  • Additional Challenges
  • Criminal Background/ Probation
  • Disability
  • Foster Youth/Emancipated
  • Homeless
  • Learning
  • Mental/Emotional
  • No Diploma
  • No HS Diploma
  • Other
  • Physical
  • Substance Abuse
  • Undocumented
  • Young Parent
Please explain:

Photo Permission

Please answer if over 18, YES at times likes to take pictures of students in the office, taking workshops, and on field trips and uses the pictures in our publications. I give permission for YES to take my picture and use it in YES publications and program materias.

  • Accept
  • Deny

Self Certification & Participation Agreement

YES Progam Participation Agreement for Youth Participants


Thank you for participating in the YES program where we will help you become employment ready; learn lifelong skills and how to stand out in the job world.  Please remember that YES is not a staffing agency and does not guarantee job placement after completion of the program. However, clients who complete the program and who are diligent in their job search are most likely to get a job.


Clients who participate in the YES program must:

  • Represent YES in a professional manner and act professionally and ethically while on any job.
  • Keep YES staff informed on your job interviews and how your job search is going.
  • Notify YES staff when you are hired. This is very important for us.
  • Attend all classes and office visits in a sober and respectful state. Failure to do so will result in your dismissal that day.


Class Policy:

  • Please arrive 5-10 minutes early to all classes and interviews. Clients will need to reschedule for class if they are more than 5 minutes late.
  • During class, the facilitator has the right to dismiss any youth who is being disruptive, talking, sleeping, or otherwise inattentive. 


Mock Interview Policy:

  • NO SHOWS are not allowed. Clients, who are not able to make their mock interview, must notify YES staff FOUR or more hours prior to appointment to reschedule.
  • Clients, who do not show up, will be required to write an apology letter to the scheduled volunteer.
  • Clients must bring their completed “YES Clothing” application with them in order to interview.
  • Mock interviews are recorded and used as a teaching tool to help better your skills in interviewing. These recordings will not be shared with others without your expressed permission.


Computers/Internet Policy:

  • Under staff’s discretion, computers may ONLY be used for job or school related purposes.
  • No downloading/uploading is allowed.
  • Certain web sites and online activities are prohibited such as shopping, gambling, adult content, social media, games, and internet chat rooms.
By checking the box below, I certify and agree that this information is true and correct and agree to provide verifying documentation if it is requested. I also confirm that I have read and agree to the Policies & Procedures laid out above. *
  • I agree

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