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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* 1. County of Residence

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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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* 12. If you are 18 years of age or older, do you have someone living in your house under the age of 18?

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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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* 16. Do you have a valid driver's license?

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* 17. Do you have reliable/dependable daily transportation?

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

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* 19. If you are an out of school youth, would you be willing to work past the scheduled end date of the program?

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* 20. If you are an out of school youth, would you be interested in post secondary education?

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* 21. Today's Date

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* 22. Electronic Signature

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