North Shore Youth Career Center Membership Form

When you complete the form click on the submit button: Thank You

Personnel Information

First Name:

Last Name:

Address:

City:

Zip Code:

Date of Birth:

Male  Female

Phone:

Cell Phone:

Email:

Education Information

School/Program: 

Grade You are in: 

Graduate: Y N Graduation Year:

Currently in School: Y N

Take MCAS: Y N

Pass Reading: Y N

Pass Math: Y N

GED: Y N

Optional:

White Hispanic/Latino African/American

Asian American Indian

Other:

Check all your interests that apply:

 Office Retail Stores Banks

Landscaping Lifeguard Summer Camps

Theater Warehouse/Shipping Food Service

Other:

Only Check Places where you can get to work:

Lynn Salem Peabody Danvers

Saugus Beverly Gloucester

Other:

Do you have any training or certifications: