Goodwill Industries of Greater Cleveland and East Central Ohio, Inc. is currently accepting applications for the Summer Comprehensive Case Management Employment Program (CCMEP) summer employment.
 
By no means does the completion of this form guarantee you eligibility for the summer CCMEP program. The program is based upon TANF, WIOA and/or income eligibility guidelines. All applicants must be between the ages of 16-18 years of age and reside in Stark or Tuscarawas County. Eligibility for the program does not guarantee participation. Program participation is dependent upon job site availability, funding, and program capacity in addition to eligibility.

All of the information collected on this form will be utilized to assist in the determination of eligibility and will be kept confidential.

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* 2. First Name

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* 3. Middle Initial

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* 4. Last Name

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* 5. Address

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* 6. City

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* 7. State

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* 8. Zip Code

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* 9. Social Security Number

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* 10. Date of Birth

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* 11. Age you will be on June 19, 2018

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* 13. Graduation Year

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* 14. Phone Number

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* 15. Alternate Phone Number

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* 18. If yes, please tell us about your reliable transportation.

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* 21. Today's Date

Date / Time

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* 22. Electronic Signature

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