PERSONAL INFORMATION. 1. Name: Last Name First Name Middle Name. Address

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1 HEART Trust/NTA YOUTH SERVICES DIVISION An Agency of the Ministry of Education, Youth and Information 6 Collins Green Avenue, Kingston 5 Tel: (876) Facsimile: (876) 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 Copy of School ID Between ages with photograph attached Copy of Government Issued ID Persons with disabilities Resume Copy of Birth Certificate between ages Copy of TRN Proof of Qualification (if any) PERSONAL INFORMATION 1. Name: Last Name First Name Middle Name 2a. Date of Birth: (dd/mm/yy): / / 2b. Current Age: 2c. Sex: Male Female 3. Permanent Address: Street Name & Number Community/District 4. Contact Information: Home Phone Mobile 1 Mobile 2 Parish Address 5a. ID Type: School ID Passport Drivers License National ID 5b. ID #: 6. TRN: - - (Mandatory) 7. Are you a young person with a disability? * Yes No If yes, please tick all that apply: Physical disability Intellectual disability Other: Visually impaired Deaf *Indication of disability will not result in you being discriminated against but will support your placement. BANKING INFORMATION 9a. Do you have a Commercial Bank Account? Yes No 9b. Please state name of bank: 10a. Account No.: 10b. Branch No.: ACADEMIC PROFILE 11. Please indicate your current level of education: Secondary Tertiary Vocational Training Other: 12. How many CSEC Subjects did you pass? None Less than 3 subjects 3 or more subjects 13. Are you currently in school/ training: Yes No 14. Are you a High School Graduate? Yes No If yes, state year: EMERGENCY CONTACT 15. In the event of an emergency please notify: Emergency Contact 1: Name: Last Name First Name Relationship: Contact Number(s): - / - Emergency Contact 2: Name: Last Name First Name Relationship: Contact Number(s): - / - HEART TRUST/NTA-NSP-2017 NOT FOR SALE Page 1 of 2

2 16. Do you have any medical conditions or allergies? Yes No If yes, please state: 17. Please select preferred placement phase: June 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 MEDICAL HISTORY PERSONAL INTEREST AND SKILLS 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! Date Received: FOR OFFICIAL USE ONLY Age requirement met Resume School ID (copy) Birth Certificate (copy) TRN (copy) Proof of Qualification (copy) One passport size photo Government Issued ID (copy) Bank Verification Form Application Status: Complete Incomplete Participant Status: Eligible Ineligible Data Entry: Complete Incomplete Placement Code: Comments: Verified by: Date: HEART TRUST/NTA-NSP-2017 NOT FOR SALE Page 2 of 2

3 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 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.

4 RESUME Contact Information. Objective Name of School (s) Education History Years Attended Qualification Achieved (e.g.: # of CXCs, # of CAPE, Certificate, Diploma, Degree) Date Awarded

5 Employment History Name of Company 1: Name of Company 2: Name of Company 3: Name of Company 4: References

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