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Application For The 2015 Summer Hire Program

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APPLICATION FOR THE 2015 SUMMER HIRE PROGRAM

(PERSONAL DATA – PRIVACY ACT OF 1974)

STUDENT BACKGROUND INFORMATION

CHRO Use Only

1. Student Name (Last, First, MI):

2. Student SSN (see Note 1)

3. DOB (DD-MM-YYYY)

4. Home Telephone:

5. Mailing Address: (PSC/APO/FPO)

Place of Birth (City and State)

U.S.

Yes

Age:_______

Citizen

6. Home Address (Physical address):

SPONSOR INFORMATION

7. Sponsor’s Name (Last, First MI):

8. Sponsor’s SSN: (Required for

9. Sponsor’s Work Telephone:

10. Sponsor’s DEROS

IG Check)

11. Sponsor’s Organization Address, Branch of Service, and Unit

12. Sponsor’s E-mail Address:

EMERGENCY NOTIFICATION INFORMATION

13. Alternate emergency point of contact (Not the Sponsor):

14. Work Telephone:

15. Home Telephone:

STUDENT EDUCATION

16. Education:

Are you a full-time student? (Indicate middle or high school)

College Name:

Course of Study:

Yes

(Grade)

Are you attending a College/University?

Yes

(See Note 2)

EMPLOYMENT HISTORY AND SPECIAL SKILLS

17. Have you ever worked for the Summer Hire Program in Okinawa?

If Yes, when?

Yes

18. Do you speak any foreign languages? (If Yes, which languages)

Yes

19. Please indicate special skills that you have in working with computers.

20. How many words per minute can you type?

21. What extra-curricular activities or sports do you play or

participate in?

WORK EXPERIENCE

22. Job #1: Name of Company/Organization you worked/Volunteered at :

Dates of Employment:

Name of Supervisor/Telephone:

Tell us what you did:

23. Job #2: Name of Company/Organization you worked/Volunteered at:

Dates of Employment:

Name of Supervisor/Telephone:

Tell us what you did:

Applicant:

I consent to the release of information about my ability and suitability for Federal employment by employers, schools, law enforcement agencies, and other

individuals and organizations to investigators, personnel specialists, and other authorized employees or representatives of the Federal Government.

24. Student Signature:

25. Date:

Notes:

1. Block 2, Student SSN: The student’s SSN must be verified. Acceptable documentation is the original or copy of the dependent Social

Security Card.

2. Block 16, College Attendance Verification: A letter from the School Registrar is required which verifies attendance at the school or School

Transcripts for the current Semester/Quarter. If applying for GS-03 position, MUST submit copy of college transcripts.

See Reverse Side for Parental Consent to Work (Required if under Age 18)

Revised 03/25/15