National Summer Programme Form - National Youth Service

HEART Trust/NTA YOUTH SERVICES DIVISION An Agency of the Ministry of Education, Youth and Information 6 Collins Green Avenue, Kingston 5 Tel: (876) 754 9816-8

Facsimile: (876) 754 9820

NATIONAL SUMMER PROGRAMME APPLICATION FORM ALL SECTIONS MUST BE COMPLETED IN FULL USING BLUE OR BLACK INK INCOMPLETE APPLICATION FORM WILL NOT BE PROCESSED

REQUIREMENTS:

● Completed Application form with photograph attached ● Resume ● Copy of TRN

● Between ages 17-29 ● Persons with disAbilities between ages 17-34

● ● ● ●

Copy of School ID Copy of Government Issued ID Copy of Birth Certificate Proof of Qualification (if any)

PERSONAL INFORMATION 1. Name: Last Name

First Name

2a. Date of Birth: (dd/mm/yy):

/

/

Middle Name 2c. Sex:Male

2b. Current Age: __________

Female

3. Permanent Address: Street Name & Number

Community/District

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4. Contact Information:

Parish

-

Home Phone

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Mobile 1

Mobile 2

Email Address 5a. ID Type:

School ID Passport Drivers License National ID

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6. TRN:

-

5b. ID #:

(Mandatory)

7. Are you a young person with a disability?* Yes  No  If yes, please tick all that apply: Physical disability Intellectual disAbility Visually impaired Deaf

Other: ______________________________________

*Indication of disability will not result in you being discriminated against but will support your placement.

BANKING INFORMATION

Yes

9a. Do you have a Commercial Bank Account?

No

10a. Account No.:

9b. Please state name of bank: 10b. Branch No.:

ACADEMIC PROFILE 11. Please indicate your current level of education:

Secondary

Tertiary

Vocational Training

Other: _________________________________________________________

None

12. How many CSEC Subjects did you pass?

Yes

No

Yes

No

13. Are you currently in school/ training: 14. Are you a High School Graduate?

Less than 3 subjects

3 or more subjects

If yes, state year: _______________________

EMERGENCY CONTACT 15. In the event of an emergency please notify: Emergency Contact 1: Name: Last Name Relationship:

First Name Contact Number(s):

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/

-

-

/

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Emergency Contact 2: Name: Last Name Relationship: HEART TRUST/NTA-NSP-2017

First Name Contact Number(s): NOT FOR SALE

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MEDICAL HISTORY

Yes

16. Do you have any medical conditions or allergies?

No

If yes, please state: ______________________________________________________________________________________

PERSONAL INTEREST AND SKILLS

June

17. Please select preferred placement phase:

July

August

18. Please state preferred placement site*: ______________________________________________________________________ *Suggested placement site is not guaranteed but will help support your placement.

19. Please state your career interest: ___________________________________________________________________________ 20. Are you computer literate?

Yes

No

21. Do you have any vocational skills (eg. mechanics, carpentry, housekeeping, masonry, cosmetology, etc.) Yes No If yes, please state your skill(s): _______________________________________________________________________________________________________ 22. Please state any major volunteer activity you have participated in: _______________________________________________ _______________________________________________________________________________________________________ 23. What do you expect to gain from the programme? ____________________________________________________________ _______________________________________________________________________________________________________

GENERAL INFORMATION 24. How did you learn about the HEART Trust/NTA National Summer Programme? (Tick all that apply)

School

Radio Internet Newspaper

Family/Friend Social Media  HEART Trust/NTA Representative

Other: ____________________________________________________________________________________________________ 25. Have you ever participated in the HEART Trust/NTA Programme/ Training?

Yes

No

__________________________________________________________________________ Name of Programme/ Training

____________________ Year of participation

DECLARATION I, the undersigned, declare that the above information given in this application is correct to the best of my knowledge. I am aware that any false or misleading information will result in my application being automatically rejected. I further declare that I have attached all the required supporting documents and acknowledge that failure to submit same with a fully completed application form will result in my application being delayed or rejected. By completing this form, I have granted the HEART Trust/NTA permission to use any images captured for marketing purposes.

Signature of Applicant

Date of Declaration

HEART Trust/NTA reserves the right to assign participants in June, July or August based on available placements. THANK YOU FOR YOUR APPLICATION. WE LOOK FORWARD TO WORKING WITH YOU THIS SUMMER!

FOR OFFICIAL USE ONLY Date Received: ____________________________  Age requirement met

Birth Certificate (copy) One passport size photo

 Resume  TRN (copy)  Government Issued ID (copy)

Application Status:

Complete

Incomplete 

Participant Status:

Data Entry:

Complete

Incomplete

Placement Code:

School ID (copy) Proof of Qualification (copy) Bank Verification Form Eligible

Ineligible

Comments: _______________________________________________________________________________________________ _______________________________________________________________________________________________

Verified by: _________________________________ HEART TRUST/NTA-NSP-2017

Date: ___________________________________ NOT FOR SALE

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Instructions to complete resume In completing your resume, please be guided by the following instructions: Your Contact Information should include your full name, your address, your telephone number(s) and your email address. Your Objective is a statement of what your goals are and what benefit you will be able to add to the workplace. In the Education History section, you are required to list the names of the school/institution(s) you have attended and the qualification you have attained (example: The Queen High School (CXC)). Always ensure that you begin with the most recent information first. If you are a student attending a tertiary institution, you can specify the area of study and indicate that it is pending. In the Employment History section you should include the name of the two most recent companies, positions held, the duration and duties performed; again, you should begin with the most recent information first. Your References should be individuals (excluding family members) who can verify the information you have written and recommend you as a suitable candidate for this programme. The contact information for your references should include full name, address and telephone number.

RESUME Contact Information

…………………………………………………… …………………………………………………… ……………………………………………………. …………………………………………………… Objective ……………………………………………………………………………………………………………… ……………………………………………………………………………………………………………… ………………………………………………………………………………………………………………

Education History Name of School (s)

Years Attended

Qualification Achieved (e.g.: # of CXCs, # of CAPE, Certificate, Diploma, Degree)

Date Awarded

Employment History Name of Company 1:

Name of Company 2:

Duration:

Duration:

Position Held:

Position Held:

Key Responsibilities: (Skills used to carry out the job)

Key Responsibilities: (Skills used to carry out the job)

Name of Company 3:

Name of Company 4:

Duration:

Duration:

Position Held:

Position Held:

Key Responsibilities: (Skills used to carry out the job)

Key Responsibilities: (Skills used to carry out the job)

References 1. …………….………………………………...

2. …………….………………………………...

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