SUMMER EMPLOYMENT APPLICATION (Side A)
Application should be typed

PART A. APPLICANT INFORMATION
1. NAME (Last, First, MI)

2. DATE OF BIRTH (MMDDYY)

4. MAILING ADDRESS

5. RESIDENCE ADDRESS

6a. APPLICANT’S E-MAIL ADDRESS

6b. SPONSOR’S WORK E-MAIL ADDRESS

7. PHONE NUMBER

8. DRIVER’S LICENSEYES

3. SOCIAL SECURITY NUMBERNO

9. TYPE OF POSITIONS: Clerk and Laborer positions are
10. LOCATION OF POSITIONS: Employees are required toavailable. Please indicate the type of position you are willing to provide their own transportation to and from work. Positions
accept and your 1st and 2nd choice:
are located on Kadena Air Base.
CLERK_______________________LABORER_______________________

11. Indicate if any special accommodations are needed or if allergies exist
Requires Sponsor’s signature __________________________
12. APPLICANT’S CERTIFICATIONI certify that, to the best of my knowledge and belief, all of the information on and attached to this application is true, correct,
complete and made in good faith. I understand that false or fraudulent information on or attached to this application may begrounds for not hiring me or for firing me after I begin work, and may be punishable by fine or imprisonment. I understand that
any information I give may be investigated.
NOTE: APPLICANT IS REQUIRED TO SUMBIT A COMPLETE APPLICATION PACKAGE INCLUDING ALL REQUIRED DOCUMENTS
AS LISTED ON THE SUMMER HIRE PROGRAM APPLICATION CHECKLIST. APPLICANTS MUST HAVE A BANK ACCOUNT FOR
DIRECT DEPOSIT OF PAY BEFORE BEGINNING EMPLOYMENT (may be a parent’s account). U.S. CITIZEN MALES WHO WILL BE18 BY THE BEGINNING OF THE PROGRAM MUST BRING CERTIFICATION OF REGISTRATION WITH THE SELECTIVE SERVICESYSTEM. FOR SELECTIVE SERVICE REGISTRATION INFORMATION CONTACT THE KADENA LAW CENTER AT 634-3300.
______________________________________________APPLICANT’S SIGNATURE___________________________DATEPART B. SPONSOR INFORMATION AND APPROVAL
1. SPONSOR’S NAME/RANK

2. ORGANIZATION/BASE

3. DUTY PHONE

4. DEROS5. SPONSOR’S CERTIFICATION AND APPROVAL
I certify I (or my spouse) am employed by the U.S. Military, Civil Service, NAF, or AAFES and the above applicant ismy dependent. I authorize my dependent to participate in the Summer Employment Program. My dependent haspermission to perform the types of work listed, and to the best of my knowledge, is physically able to perform theduties required. I further authorize emergency medical care for any job-related injury or illness sustained while mydependent is employed as a summer hire employee. I understand work hours are established by the organization
employing my dependent and may include weekends or early evenings. I further understand I may not
request/specify a particular organization in which my dependent may work.
______________________________________________SPONSOR’S (OR SPONSOR’S SPOUSE) SIGNATURE

18 Wing, Form 0-99, Mar 2011__________________________
DATE

SUMMER EMPLOYMENT APPLICATION(Side B)

PART C. EXPERIENCE AND EDUCATION
1. DESCRIBE PAID AND NONPAID WORK EXPERIENCES.
Job Title
From (month/year)

Employer’s Name

To (month/year)

SalaryEmployer’s Address

Hours per Week

Describe your duties and accomplishments.

Job Title

From (month/year)

Employer’s Name

Employer’s Address

To (month/year)

SalaryHours per Week

Describe your duties and accomplishments.

2. HIGH SCHOOL/COLLEGE INFORMATIONName of School

Highest Grade Completed:

Some HS

College Major/Minor

HS/GED

Some CollegeAssociateBachelor

3. OTHER QUALIFICATIONS (Include typing, computer skills, honor roll, awards/accomplishments, membership in National
Honor Society, etc.)

FOR OFFICIAL USE ONLYSOFA STATUS VERIFIEDYES ( X) NO ( )BIRTH DATE VERIFIED YES (X ) NO ( )SSN VERIFIEDYES ( X) NO( )ORDERS VERIFIEDYES ( X ) NO ( )PLACEMENT CATEGORYClerk

PERSONNELIST INITIALS JM

PRIVACY ACT AND PUBLIC BURDEN STATEMENTS• Where the applicant’s identification number is a Social Security Number, collection of this information is
authorized by Executive Order 9397. Furnishing the information on this form, including your Social
Security Number, is voluntary, but failure to do so may prevent the application from being considered.
• We may give information from your records to officials in litigation or administrative proceedings where
the Government is a party; law enforcement agencies concerning violations of law or regulation; Federal
agencies for statistical reports and studies.
• We may also give information from your records to: prospective nonfederal employers concerning tenureof employment, civil service status, length of service, and date and nature of action for separation asshown on personnel action forms of specifically identified individuals; requesting organizations orindividuals concerning the home address and other relevant information on those who might havecontracted an illness or been exposed to a health hazard; authorized Federal and nonfederal agencies foruse in computer matching.
18 Wing, Form 0-99, Mar 2011