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The 2019 Northern Virginia EYE Program ApplicationDavid Hunn2019-03-18T15:31:04-04:00

The 2019 Northern Virginia EYE Program Application

Name *

First

Last

Age

Gender

Male
Female

Date of Birth

Phone

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Desired Work Experience Location

Work Experience

Employer

Position

City/State

Start Date

End Date

Reason for Leaving

Description of Duties

Additional Work Experience

Employer 2

Position 2

City/State 2

Start Date 2

End Date 2

Reason for Leaving 2

Description of Duties 2

Additional Work Experience

Employer 3

Position 3

City/State 3

Start Date 3

End Date 3

Reason for Leaving 3

Description of Duties 3

Availability from June to August

Sunday: From

To

Monday: From

To

Tuesday: From

To

Wednesday: From

To

Thursday: From

To

Friday: From

To

Saturday: From

To

Education

High School

College

Grade/Years Completed

College Major (if applicable)

Interests/Skills

Please number 1 through 3 your areas of career interest to assist us in establishing your work site.

Healthcare

Automotive

Finance/Accounting

Retail

Technology

Construction

Administrative

Other Interest Level

1. Describe any skills, job interests, or hobbies that would qualify you for the above work (include any training or technical skills, ex: typing speed, Microsoft Office, etc.)

2. Give two reasons why you think you would be a good candidate for the EYE Program

3. How would you get to work?

Drive myself
Public transportation
Walk or ride bike
Get a ride from:

4. Additional Information

Have you ever been convicted of a crime?

Yes
No

If yes, please provide date, location, nature of offense, and fine or sentence.

5. Do you require any special accommodations?

Yes
No

If yes, please explain.

If you have a resume, please attach it here

Click or drag a file to this area to upload.

The goal of the Northern Virginia EYE Program is to help young adults to gain work experience, employment skills, and confidence to succeed in the workforce. Please note that youth will be required to attend regular training sessions throughout the summer.

Phone

Virginia Career Works – Northern Administrative Offices

8300 Boone Boulevard
Suite 450
Vienna, Virginia 22182
T: (703) 827-3782 (VA Relay: 711)
Toll-Free: (833) 365-2011
F: (703) 827-3785
Email: info@vcwnorthern.com

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