Georgia C.R.E.W. Application

Institution Type (required)

High School

GED Program

Vocational Technical

Other

Current

Current

Employment Status

Intern (paid)

Intern (not paid)

Full-time

Part-time

volunteer

Job History 2

Employer

Employer Address

Position Title

Phone number

Supervisor's Name

Start Date

End Date

Employment Status

Intern (paid)

Intern (not paid)

Full-time

Part-time

volunteer

Salary

$ ____ per

Salary - None - Hourly Weekly Bi-weeklyYearly

Gender

Male

Female

Race

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Housing Type (required)

Foster Home

Group Home

Other

Do you have reliable transportation? (required)

Yes

No

Have you participated with Georgia C.R.E.W. (formally TeenWork Internship Program) before? (required)

Yes

No

If yes, how many years? (required)

0

1

2

3

4