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Private Sector Job Connection Application

The information collected on this form will be used to help assess your qualifications for a variety of internship/employment opportunities. The data on this form may be shared with potential work sites.
Personal Information

Date of Birth 

Last Name    

First Name       M.I. 

Street Address   Apt No. 

City    State     Zip Code

Home Phone  Cell Phone 


Gender    Male    Female
Race  African-American    Asian-American  
   Caucasian    Latino  
   Muiti-Racial    Native-American  

US Citizen/Authorized to work    Yes  No

Do you have a valid driver's license?  Yes   No     

Do you have regular access to a car?  Yes  No

Current or last high school attended     
Completed High School/GED   Yes    No    Enrolled    

Year of Graduation

Are you currently enrolled in college or other training?   Yes  No 

Name of school/traning provider


Please upload a copy of your resume.
Students who do not submit a resume, will not be considered for employment.

Please title your resume as: Last name, First Initial Resume Date
Examples: YangF Resume 2-28-2015  or   SamsonL Resume 3-1-2015


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Kenneth Gales

(414) 286-5814