Register for Youth in Action: Summer Work Experience

I hereby grant permission to Community Living Essex County to contact previous employers, schools, and other organizations indicated on this application (unless indicated otherwise) and I hereby authorize my former employers, schools and other organizations indicated to provide information concerning employment, education and/or character.

I hereby release those individuals or organizations from any and all liability and damages for providing such information.

I hereby declare that the information contained in this application is true and complete to the best of my knowledge. I understand that any omission or misrepresentation of information on this application may disqualify me from Youth in Action: Summer Work Experience.