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Youth Leadership Application
Applicant's First Name *
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Applicant's Last Name *
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Address *
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City *
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State *
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Zip Code *
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Applicant's Phone Number
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Date of Birth *
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Age *
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Sex *
Race
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School *
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Grade *
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Applicant Lives with: *
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Father/Guardian's First Name: *
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Father/Guardian's Last Name: *
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Cell-Phone: *
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Email: *
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Mother/Guardian's First Name *
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Mother/Guardian's Last Name: *
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Cell Phone: *
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Email: *
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Emergency Contact (Other than parents or Guardians) *
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Cell Phone: *
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What are your career interests? *
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Previous training or experience? *
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Do you have a license? *
Driver's License Number: *
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Do you have any traffic violations? *
What/when? (for traffic violations) *
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Do you have arrests for crime? *
If so, what?
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Have you been convicted of a crime? *
If so, what?
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Have you ever used drugs? *
If so, what did you use?
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Have you been suspended? *
If so, explain.
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Have you been expelled? *
If so, explain.
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GPA when you last attended school? *
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Reference Name: (all applicants must have at least 1 letter of recommendation, can email it to pal@citrusheights.net) *
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Phone Number *
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Relationship: *
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Please tell us why you are the ideal candidate for the Youth Leadership Council, and in your own words, explain what commitment means to you: *
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