Cocoa Works Summer Youth Employment Program Application

2. Before applying, please make sure you will be able to fully participate. This program is time intensive and should be carefully considered by highly committed students. If you are planning to take a vacation or go to school during the program, then this is not the program for you. All candidates will be drug tested and background checked.

   Before applying, please make sure you will be able to fully participate. This program is time intensive and should be carefully considered by highly committed students. If you are planning to take a vacation or go to school during the program, then this is not the program for you. All candidates will be drug tested and background checked.

4. Please note the Commitment and School Certification Form below must be downloaded, completely filled out, signed and then uploaded to this application. Application is not complete without this form completed in full. This application cannot be saved once started, so have this form complete before filling out the application below.

   Please note the Commitment and School Certification Form below must be downloaded, completely filled out, signed and then uploaded to this application. Application is not complete without this form completed in full. This application cannot be saved once started, so have this form complete before filling out the application below.

6. To be Eligible, Applicants Must:

   1)Be a resident of Cocoa (proof of residency required). 2)Be a current Junior or Senior (planning to graduate in May 2019), with good academic standing. 3)Minimum age is 16 years old. Some positions have a minimum age requirement of 18 years old. 4)Make a commitment to full participation in the Cocoa Works Program. 5)Have a desire to develop and utilize financial, work readiness and work experience skills. 6)Be able to provide or arrange their own transportation for all program components.

   1)Be a resident of Cocoa (proof of residency required). 2)Be a current Junior or Senior (planning to graduate in May 2019), with good academic standing. 3)Minimum age is 16 years old. Some positions have a minimum age requirement of 18 years old. 4)Make a commitment to full participation in the Cocoa Works Program. 5)Have a desire to develop and utilize financial, work readiness and work experience skills. 6)Be able to provide or arrange their own transportation for all program components.

8. Successful Completion of the Program Includes Approximately:

   1)25 hours of Work Readiness Training 2)125 hours of paid work experience

   1)25 hours of Work Readiness Training 2)125 hours of paid work experience

10. Instructions:

    1)Please complete each section in full. 2)Type or print legibly in black ink. 3)Include necessary signatures. 4)Complete applications must be received no later than May 3, 2019 (please keep a copy of your application).

    1)Please complete each section in full. 2)Type or print legibly in black ink. 3)Include necessary signatures. 4)Complete applications must be received no later than May 3, 2019 (please keep a copy of your application).

12. Selection Process:

    1)A CareerSource Brevard rating committee will review all applications and select approximately 12 candidates. Selected Cocoa Works participants will be notified by May 15, 2019. 2)This is a needs-based program. Selection criteria will be based on the financial need of the applicants. Additional documentation may be requested.

    1)A CareerSource Brevard rating committee will review all applications and select approximately 12 candidates. Selected Cocoa Works participants will be notified by May 15, 2019. 2)This is a needs-based program. Selection criteria will be based on the financial need of the applicants. Additional documentation may be requested.

14. 2019 Program Dates:

    Week of June 3-4, 2019 - Foundations Training Week at CareerSource Brevard (Rockledge); June 7, 2019 - Interview Day at City Hall (Cocoa) and Employer Selection (Students will be notified about their internship placement); June 17-July 19, 2019 - Paid Work Experience, 25 hours per week at $8.46/hour; July 24, 2019 - Graduation at the Cocoa City Council Meeting

    Week of June 3-4, 2019 - Foundations Training Week at CareerSource Brevard (Rockledge); June 7, 2019 - Interview Day at City Hall (Cocoa) and Employer Selection (Students will be notified about their internship placement); June 17-July 19, 2019 - Paid Work Experience, 25 hours per week at $8.46/hour; July 24, 2019 - Graduation at the Cocoa City Council Meeting

18. Commitment and School Certification

    Please download and complete the Commitment and School Certification form in the link provided below and then upload to this application. Application will not be complete until this form is signed and upload.

    Please download and complete the Commitment and School Certification form in the link provided below and then upload to this application. Application will not be complete until this form is signed and upload.

20. Link to Commitment and School Certification Form

    Commitment and School Certification Form

21. Completed Commitment and School Certification Form*

    This form must be completely filled out, signed and uploaded to this application. Application is not complete without this form completed.

25. Personal Information

27. First Name*

28. Last Name*

30. Date of Birth*
    Date of Birth

32. Address1*

34. Address2

36. City*

37. State*

38. Zip*

40. Student Phone Number*

41. E-mail Address

43. Parent(s)/Guardian(s) Name*

45. Cell Phone Number

46. Household Income*

48. Emergency Contact (Name and Telephone Number):*

52. School Information

54. Current School*

56. School Address

58. City

59. State

60. Zip

62. Grade Level in '18-19*

63. Current Grade Point Average*

67. Questions

    Please answer each question in full. Answers should be typed and at least a paragraph long. Incomplete or illegible answers will not be considered.

    Please answer each question in full. Answers should be typed and at least a paragraph long. Incomplete or illegible answers will not be considered.

69. 1. Please explain what you hope to gain as a participant in the Cocoa Works Summer Youth Employment Program.*

71. 2. What are your long term education and/or career goals?*

73. 3. Why should you be chosen to participate in the Cocoa Works Summer Youth Employment Program?*

Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit Submit and Print

* indicates a required field