First Name Address Mobile Phone Email Start Date

MI City Home Phone School Attending End Date

Last Name State Zip

Availability: Times Available On Specified Days

EXAMPLE M 4PM-6:30PM T n/a W 3:30PM-6PM TH n/a F 3PM-6PM

TH

F Dates
June 13th 2011 Aug 12th 2011

Recent Work And Volunteer Experiences: Organization

EX: Rosemead Youth Leadership Center

Work Performed
Created flyers for various campus events

Skills: (Photoshop, Photography, Publisher, Video Edit Software, Bilingual etc)

Personal Goals:

RYLC Expectations: Why are you here?

Don't Print, Save Trees

https://www.PDFescape.com

Make An Account

The Application Requirements: Please read carefully as our application process has updated. A) Read the following and proceed to the appropriate sections. I. 18 years of age and over: See section (B). II. Under 18 years of age: See section (C). B) Required Refundable Live Scan- (See Page 3 - Form | Refundable only after 72 hours of service) BEYOND SERVICES 1461 E. Valley Blvd. Alhambra, CA 91801 $10.00 Call for store hours. C) Required Parent/Guardian Authorization- (Acknowledge statement by signing below) I understand my child's desire to participate in the RYLC Youth Leadership Program. My signature below authorizes my childs participation with the program and represents my childs acknowledgement of the terms and conditions to complete the program. X________________________________________ Parent/Guardian Print Name ________________________________________ Parent/Guardian Signature/Date

D) Emergency Contact Information- (Must be 21 years of age and over) Name Relationship Contact Address

Zip Code

E) Have all documents ready for mandatory term OrientationCheck List: 1) [ ] Application 2) [ ] Resume 3) [ ] Reference(s) (1) for Volunteer. (2) for Internship 4) [ ] Report card or Progress report 5) [ ] Live Scan or Parent/Guardian Signature Communication weighs heavily on emails and Facebook. Conduct appropriate behavior online while you're with the program as you will be representing RYLC. By signing below you acknowledge and agree to the RYLC term and conditions. X________________________________________ Student Print Name ________________________________________ Student Signature/Date

Tips and Q&A: In this section, youll find tips and tricks on how to complete the application process. The most common problem is how to create a resume. Below you will find that and many more examples. Please also take the opportunity to look at the Q&A (Questions & Answers) which may answer some of your inquiries. Helpful Suggestions: If you are using Microsoft Office, you can find a helpful template through these easy steps. 1) First, hit the Office Icon 2) Next, hit New Document 3) Then, scroll down templates and hit Resumes and CVs 4) Lastly, select Basic Resumes and choose a template to start on. Helpful Links: This is a link to an excellent example of a resume from a high school student. This is a link to an excellent example of an email inquiry from a high school student. Questions & Answers: Top 5 questions and answers about the application process. Q: What if my handwriting is illegible? A: To be safe rather than sorry, please type out all information on application process using a typewriter, Photoshop or PDFescape.com. Illegible or incomplete applications will be automatically denied. Q: What is a recommendation / reference letter? A: This letter is written from someone who can validate your character and ability to be accepted to our program. This can be written by your instructor, a business owner you work closely with or a past supervisor/manager. Q: What if I cannot pay for the Live Scan $10.00 fee? A: We would be more than happy to try and work something with you so that you can participate. Everyone deserves an opportunity and we dont believe denying youths the privilege of being with our program. Q: What if my parent/guardian will not sign off on me participating with the Youth Leadership Program? A: We would be more than happy to have a sit down conference with you and your parents/guardians to discuss what the program is all about before they finalize their decision. Our other recommendation is waiting until youre 18+. Q: What if I cant make it to the Orientation date? A: In order to start in the program, you will need to attend the mandatory Orientation. If you cant make it to the meeting, youll have to wait until the next Open Enrollment which varies through each term. Add: RYLC PAGE Add: RYLC GROUP Add: Homework First (SSA)

State of California

Department of Justice

REQUEST FOR LIVE SCAN SERVICE

BCil 8016 (3/04

Glear Form

Applicant Su0mrssion

oRl:

AF103
Code assigned by DOJ

Type of

Application: VOLUNTEER l VCA (92072\

'

Job Title or Type of License, Certification or Permit:

Agency Address Set Contributing Agency:

M. JANET CHIN YOUTH FOUNDATION

Agency authorized to receive criminal history information

16206
Mail Code (five-digit code assigned by DOJ)

3592 ROSEMEAD BLVD #449

Street

No.

KENO DEARY
Contact Name (Mandatory for all school submissions)

Street or PO Box

ROSEMEAD CA
City
Name of Applicant:
iPlease print)

State

91770 Zip Code

(626 ) 789-6579
Contac-t Telephone No.

Alias:
LA$
FITSI

Driver's License No:

Date of Birth:

sex:
Weight:

l-l

Mate

l-l

Femare

Misc. No. BtL

151940
Agency Billing Number

Height:

Misc. Number: Home Address:

Eye Color: Place of Birth:

Hair Color:
Street

No.

Street or PO Box

City, State and Zip Code

Social Security Number:

Your Number:
OCA No. (Agency ldentifying No.)

Levelof Service:

lf resubmission, list Original ATI

Number: EmplOyef:
(Additional response for agencies specified by statute)

oO.l

Employer Name

Street No

Street or PO Box

Mail Code (five digit code assigned by DOJ)

City

()
State
Zip

Code

Agency Telephone No. (optional)

Live Scan Transaction Completed By:

Date

Transmitting Agency

ATI No.

Amount CollectedlBilled

ORIGINAL

- Live Scan Operator; SECOND

COPY

Applicant; THIRD COPY (if needed)

- Requesting

Agency