Teens of Distinction Employment Program Application

Applicant Information
Last Name: First Name: M.I.

Date of Birth: Current age:

Address:

City/State: Zip Code: Ward:

Home phone: Social Security #:

Cell phone: e-mail address:

Are you a citizen of the United States? Yes No

If no, are you authorized to work in the U.S.? Yes No

This position runs during the school year. Can you work a minimum of 10 hours per week?
Yes No
Are you available to work:
Saturdays? Y N Sundays? Y N
M-F 9:30 am-3:30 pm? Y N M-F 3:30 pm -9 pm? Y N

Education
Are you currently in school? Y N
(If yes, proceed to section I. If no, proceed to section II.)
I.
High School name:
Did you graduate?: Y N

Current grade level (10th, 11th, etc):

Current GPA (please attach a copy of your most recent report card or transcript):

College or University name:

Current grade level (freshman, sophomore, etc.):

II.
If you are currently enrolled in a GED program, list the name of your program (please attach a letter
from the program director confirming your enrollment and successful participation):

If you are out of school and not in a GED program, mark this box:

Background Information

Use the back of this page or an additional page to summarize any special skills and
qualifications that you have acquired from any previous employment, volunteer
work, community and extracurricular activities, and any membership in clubs or
organizations. Include any awards, honors, or special recognition you have received.
You can also provide this information by attaching a cover letter and résumé (in fact,
this is preferred).
 Previous Employment
(if no previous employment, leave blank)
1. Company: Phone #:

Address: Supervisor:

Responsibilities:

Worked from: / / to: / / Salary/wage:

Reason for leaving:

2. Company: Phone #:

Address: Supervisor:

Responsibilities:

Worked from: / / to: / / Salary/wage:

Reason for leaving:

Library Selection
Circle the Library locations where you are willing to work. Put a star next to your first choice. Consult
dclibrary.org for site location information.

NE locations: Lamond-Riggs Northeast Woodridge Benning

NW locations: Chevy Chase Cleveland Park Shepherd Park/Juanita Thornton

Palisades Petworth Takoma Park West End

Mount Pleasant

SE locations: Capitol View Francis Gregory Southeast Anacostia

Parklands-Turner

SW locations: Southwest Washington Highlands

Martin Luther King, Jr. Memorial Library (MLK, Central Library)

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to
employment, I understand that false or misleading information in my application or interview may result
in my release. Pursuant to DC Official Code [1-616.51et.seg. (2001)]
Signature: Date:

Submit your completed application form, cover letter and resume (if you decide to do one), 2 letters
of recommendation (from a teacher, advisor, mentor, or former supervisor), and report card,
transcript, or GED program letter by Friday August 28, 2009 to:

Human Resources Department, Room 453

Martin Luther King, Jr. Memorial Library
901 G Street, NW, Washington DC 20001
Hours: Monday-Friday 9:30 am-5:30 pm