2013 SUMMER EMPLOYMENT PACKET ~ DIRECTIONS (Read 1...

2013 SUMMER EMPLOYMENT PACKET ~ DIRECTIONS

(Read 1st before completing the application)

You must be 14-21 years of age to apply for a summer job. If you are currently 13 you must turn

14 by May 22nd

to apply.

Application – DEADLINE WEDNESDAY, MAY 22ND

at 5PM

Proof of residency is required. The ONLY items which will be accepted are:

o White Plains school district report card

o Utility Bill (electric or gas)

o Tax Bill

There are a limited number of interview slots per placement. They are 1st come first

serve. Once the slots have been filled YES will require you to change that job selection.

Identification

If you are 14-17 you must submit a work permit.

If you are 18 and older you must submit photo ID.

You will need to submit a 2nd

form of ID which could either be a passport, social security

card, or birth certificate.

If your 16th birthday falls between May 22

nd – June 30

th you MUST obtain a new work

permit and submit it to the YES office before your summer job begins.

Job Fair

Once you have submitted your application packet, identification, and resume, you will be

invited to the Job Fair, Tuesday, June 4th

3-5pm at the Crowne Plaza Hotel. You

MUST attend the Job Fair to be considered for a summer job.

Job Notification

On either Thursday, June 13th

11am-5pm or Friday, June 14th 2-5pm, you must come to

the Youth Bureau, 11 Amherst Place to receive written notification regarding whether or

not you will receive a summer job placement. If you do not pick up your letter your

placement will be given to someone else.

Orientation

Youth Bureau orientation is mandatory. When you pick up your employment letter you

will sign up for an orientation. The following dates are available: Choose One!

DATE TIME LOCATION

Tuesday, June 18th

3:30-5:30pm WP Library (2nd floor auditorium)

Wednesday, June 19th

3:30-5:30PM WP Library (2nd floor auditorium)

Pay Rates There will be no increase of pay rates for the summer of 2013. If you worked with us

previously pay rates are subject to change.

Dates of Employment

Summer employment runs July 1st- August 9

th. You will only be paid for that time

period. If you receive a summer job and they ask you to work before or after those dates

or to attend orientation, the Youth Bureau will NOT PAY you for that time.

Minor’s Employment & Relinquishment Form (Must be notarized)

You may use any notary service you choose, there are many in the White Plains area.

However, a notary is available at the Youth Bureau at no charge. Laura Montoya, notary,

is available Monday-Friday 9:30-12 and 2-4:30pm. Be aware that your parent must be

present and provide photo ID, when you have the form notarized. The form should not be

signed prior to arriving at the notary's office since it must be signed in the presence of the

notary.

APPLICATION DEADLINE WEDNESDAY, MAY 22ND

5PM For Staff Use:___________ (Initials, date submitted)

APPLICATIONS ONLY ACCEPTED IN BLUE OR BLACK INK. WRITE NEATLY!

**ONLY USE 1 COLOR INK THROUGHOUT THE ENTIRE APPLICATION

________________________ ________________ _____ _________ _____ Name School Age Date of Birth Ethnicity

_____ Summer Employment Application (Print & sign using your full legal name)

_____ Code of Ethics & Personnel Policies Receipt

_____ W-4 Form

_____ I-9 Form

_____ Retirement System Form

_____ Medical Release - Emergency Info

_____ Job Fair Interview Request Form

_____ Release

_____ Minor’s Employment & Relinquishment Form (Must be notarized)

PROVIDE COPIES OF THE FOLLOWING DOCUMENTS

_____ Passport OR Birth Certificate OR Social Security Card

_____ Work Permit OR If 18 or over include photo ID

_____ Permanent Resident Card (for non-citizens)

_____ Proof of Residency (Copy of a current utility bill or WPHS report card)

_____ Resume (Please use format provided – available on website)

For Parent/Guardian

My child will be available for the entire 6 week YES summer employment program Yes or No

Monday, July 1st

- Friday, August 9th. I understand that if they accept a job Please circle one

and do not fulfill their 6 week obligation they will not be eligible for future summer

employment opportunities & will loose their job placement upon returning from vacation.

_____________________________ _______________

Parent/Guardian Signature Date

CITY OF WHITE PLAINS255 MAIN STREET, WHITE PLAINS, NY 10601

Summer Employment Application G NewG Rehire

Type of Work Desired:

Dates Available:

- -

Last Name First M.I. Social Security Number

Home Address City State Zip

(Mailing address if different)

Age: Under 18* Yes No

Telephone# E-mail address U.S. Citizen**: Yes No

EDUCATION

High School Name & Location:

Dates Attended: Graduation Year:

College Name & Location:

Dates Attended: Major: Degree:

EMPLOYMENT HISTORY

Dates: Firm Name Title Ph#

Duties:

OTHER RELEVANT EXPERIENCE AND/OR SKILLS, LICENSES

(1)

(2)

(3)

REFERENCES(1)

(2)

Name of Parent or Guardian: Phone # in case of emergency:

I declare that the information given above is complete and correct to the best of my knowledge.

Applicant’s Signature Date

EQUAL OPPORTUNITY EMPLOYER*Requires working papers: Student Non-Factory, Student General and Full-Time Employment Certificate issued by State Department of Labor and parent or guardian permission to work.**Requires proof of citizenship or proof of permit to work as a non-citizen.

CODE OF ETHICS AND PERSONNEL POLICIES RECEIPTAND EEOC REPORTING

This form is intended to notify newly hired employees of certain terms of employment as requiredby law and to collect information related to the mandatory reporting by the United States EqualEmployment Opportunity Commission (EEOC).

255 MAIN STREET This form should be submitted to the Personnel Department after an acceptance of an offer ofWHITE PLAINS, NY 10601 employment. The information contained on this form is not part of the employment application

and is not used in selection for employment.

Failure to return the form timely may delay receipt of first paycheck. You will receive your pay by direct deposit to the account(s) and institution(s) of your choice, unless you specifically request payment by paper check. Direct deposits are typically processed faster than paper checks and eliminate the need for a trip to the bank.

EMPLOYEE NAME: DEPT: (PRINT)

WE REQUIRE THE FOLLOWING INFORMATION IN ACCORDANCE WITH EEOC REPORTING:The information supplied will in no way affect your employment candidacy.

GENDER: 9 Male 9 Female

RACE/ETHNICITY: Please check one only:9 W - White / Caucasian (Non-Hispanic origin) 9 A - Asian or Pacific Islander9 B - Black / African American (Non-Hispanic origin) 9 I - American Indian or Alaskan Native9 H - Hispanic

SPECIAL STATUS: 9 Veteran 9 Exempt Volunteer Firefighter

Original to Personnel with PPAF

Copy in Dept Files

9 CODE OF ETHICS: I have received a copy of the White Plains Code of Ethics on the date set forth below

EMPLOYEE SIGNATURE: DATE:

9 PERSONNEL POLICIES: I have received a copy of the White Plains Personnel Policies on the date set forth below

EMPLOYEE SIGNATURE: DATE:

Form W-4 (2013)Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.

Exemption from withholding. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2013 expires February 17, 2014. See Pub. 505, Tax Withholding and Estimated Tax.

Note. If another person can claim you as a dependent on his or her tax return, you cannot claim exemption from withholding if your income exceeds $1,000 and includes more than $350 of unearned income (for example, interest and dividends).

Basic instructions. If you are not exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations.

Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages.

Head of household. Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information.

Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances.

Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you may owe additional tax. If you have pension or annuity

income, see Pub. 505 to find out if you should adjust your withholding on Form W-4 or W-4P.

Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details.

Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.

Check your withholding. After your Form W-4 takes effect, use Pub. 505 to see how the amount you are having withheld compares to your projected total tax for 2013. See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married).

Future developments. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted at www.irs.gov/w4.

Personal Allowances Worksheet (Keep for your records.)A Enter “1” for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . A

B Enter “1” if: { • You are single and have only one job; or• You are married, have only one job, and your spouse does not work; or . . .• Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.

} B

C Enter “1” for your spouse. But, you may choose to enter “-0-” if you are married and have either a working spouse or more than one job. (Entering “-0-” may help you avoid having too little tax withheld.) . . . . . . . . . . . . . . C

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . DE Enter “1” if you will file as head of household on your tax return (see conditions under Head of household above) . . EF Enter “1” if you have at least $1,900 of child or dependent care expenses for which you plan to claim a credit . . . F

(Note. Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.) G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.

• If your total income will be less than $65,000 ($95,000 if married), enter “2” for each eligible child; then less “1” if you have three to six eligible children or less “2” if you have seven or more eligible children.

• If your total income will be between $65,000 and $84,000 ($95,000 and $119,000 if married), enter “1” for each eligible child . . . GH Add lines A through G and enter total here. (Note. This may be different from the number of exemptions you claim on your tax return.) ▶ H

For accuracy, complete all worksheets that apply. {

• If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments Worksheet on page 2. • If you are single and have more than one job or are married and you and your spouse both work and the combined earnings from all jobs exceed $40,000 ($10,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 to avoid having too little tax withheld.• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.

Separate here and give Form W-4 to your employer. Keep the top part for your records.

Form W-4Department of the Treasury Internal Revenue Service

Employee's Withholding Allowance Certificate▶ Whether you are entitled to claim a certain number of allowances or exemption from withholding is

subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS.

OMB No. 1545-0074

20131 Your first name and middle initial Last name

Home address (number and street or rural route)

City or town, state, and ZIP code

2 Your social security number

3 Single Married Married, but withhold at higher Single rate.

Note. If married, but legally separated, or spouse is a nonresident alien, check the “Single” box.

4 If your last name differs from that shown on your social security card,

check here. You must call 1-800-772-1213 for a replacement card. ▶

5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 56 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . . 6 $

7 I claim exemption from withholding for 2013, and I certify that I meet both of the following conditions for exemption.• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and• This year I expect a refund of all federal income tax withheld because I expect to have no tax liability.If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . . ▶ 7

Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete.

Employee’s signature (This form is not valid unless you sign it.) ▶ Date ▶

8 Employer’s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) 9 Office code (optional) 10 Employer identification number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 10220Q Form W-4 (2013)

Form W-4 (2013) Page 2 Deductions and Adjustments Worksheet

Note. Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income.1 Enter an estimate of your 2013 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state

and local taxes, medical expenses in excess of 10% (7.5% if either you or your spouse was born before January 2, 1949) of your income, and miscellaneous deductions. For 2013, you may have to reduce your itemized deductions if your income is over $300,000 and you are married filing jointly or are a qualifying widow(er); $275,000 if you are head of household; $250,000 if you are single and not head of household or a qualifying widow(er); or $150,000 if you are married filing separately. See Pub. 505 for details . . . 1 $

2 Enter: { $12,200 if married filing jointly or qualifying widow(er)$8,950 if head of household . . . . . . . . . . .$6,100 if single or married filing separately

} 2 $

3 Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . 3 $4 Enter an estimate of your 2013 adjustments to income and any additional standard deduction (see Pub. 505) 4 $5 Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to

Withholding Allowances for 2013 Form W-4 worksheet in Pub. 505.) . . . . . . . . . . . . 5 $6 Enter an estimate of your 2013 nonwage income (such as dividends or interest) . . . . . . . . 6 $7 Subtract line 6 from line 5. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . 7 $8 Divide the amount on line 7 by $3,900 and enter the result here. Drop any fraction . . . . . . . 89 Enter the number from the Personal Allowances Worksheet, line H, page 1 . . . . . . . . . 9

10 Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1 10

Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.)Note. Use this worksheet only if the instructions under line H on page 1 direct you here.1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 12 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if

you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than “3” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter “-0-”) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . . 3

Note. If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill.

4 Enter the number from line 2 of this worksheet . . . . . . . . . . 45 Enter the number from line 1 of this worksheet . . . . . . . . . . 56 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . 67 Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . . 7 $8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . . 8 $9 Divide line 8 by the number of pay periods remaining in 2013. For example, divide by 25 if you are paid every two

weeks and you complete this form on a date in January when there are 25 pay periods remaining in 2013. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck 9 $

Table 1Married Filing Jointly

If wages from LOWEST paying job are—

Enter on line 2 above

$0 - $5,000 0 5,001 - 13,000 1

13,001 - 24,000 224,001 - 26,000 326,001 - 30,000 430,001 - 42,000 542,001 - 48,000 648,001 - 55,000 755,001 - 65,000 865,001 - 75,000 975,001 - 85,000 1085,001 - 97,000 1197,001 - 110,000 12

110,001 - 120,000 13120,001 - 135,000 14135,001 and over 15

All Others

If wages from LOWEST paying job are—


$0 - $8,000 08,001 - 16,000 1

16,001 - 25,000 225,001 - 30,000 330,001 - 40,000 440,001 - 50,000 550,001 - 70,000 670,001 - 80,000 780,001 - 95,000 895,001 - 120,000 9

120,001 and over 10

Table 2Married Filing Jointly

If wages from HIGHEST paying job are—


$0 - $72,000 $59072,001 - 130,000 980

130,001 - 200,000 1,090200,001 - 345,000 1,290345,001 - 385,000 1,370385,001 and over 1,540

All Others

If wages from HIGHEST paying job are—


$0 - $37,000 $59037,001 - 80,000 98080,001 - 175,000 1,090

175,001 - 385,000 1,290385,001 and over 1,540

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.

TO: Employees (non-permanent/part-time)

FROM: Elisabeth WallacePersonnel Officer

SUBJECT: NOTICE OF RIGHT TO JOIN THE N.Y.S. EMPLOYEES’ RETIREMENT SYSTEM

The enclosed notice informs you of your right to join the New York State Employees’Retirement System. If you decide to join the Retirement System now, you will be enrolled as a memberof Tier 5. In making your decision, you should consider the following:

1. You must contribute 3% of your salary which will be deducted from your paycheck.

2. 10 Year Vesting - Chapter 504, Laws of 2009, Effective January 1, 2010On and after January 1, 2010, members of the retirement system with 10 or more years ofservice have a right to a retirement benefit when they reach minimum retirement age.

3. Extended Death Benefit - Chapter 388, Laws of 1998, Effective July 17, 1998This legislation provides that members who discontinue service with 10 or more years ofcredit, who die on or after January 1, 1997, are not retired, and not otherwise eligible forthe payment of a death benefit, are now eligible for a death benefit equal to ½ of thedeath benefit that would have been payable if the member had died on their last day ofcovered public employment. The benefit will be paid to the individuals last namedbeneficiary, or in the absence of a living beneficiary, to the member’s estate.

Please read, sign and return the attached form indicating your decision to join the RetirementSystem. If you decide to join, or have any questions, please call the Personnel Department to make anappointment to enroll at (914) 422-1259.

Elisabeth WallaceElisabeth WallacePersonnel Officer

Shared/Orient’n/NYSretsyRevised 5/10

DEPARTMENT OF PERSONNELCITY OF WHITE PLAINS

NOTICE OF RIGHT TO JOIN THE NYS EMPLOYEES’ RETIREMENT SYSTEM

Please read the information below carefully before deciding whether or not you wish to jointhe Retirement System; then check the appropriate box and sign your name.

If you are not a permanent, full time employee, joining the Retirement System is optional.

If you choose to join the Retirement System, your membership cannot be withdrawn and 3%of your wages will be deducted each pay day as your contribution towards retirement benefits. TheCity will also contribute towards your retirement.

If you do not join the Retirement System now, and subsequently your status changes topermanent employment so that you are required to join the Retirement System, 3% of your wageswill then be deducted from your pay. You may be eligible to receive credit for your prior service. Ifyou believe you are eligible to receive credit for prior public service covered by the NYSRS, pleasenotify the Personnel Department.

Please check one of the following:

� I have read the information above and wish to join the NYS Employees’ RetirementSystem. I understand that 3% of my wages will be deducted from my pay. (Retirement Enrollment Form must be completed; contact the Personnel Department).

� I have previous or current membership in the NYS Employees’ Retirement System.Dates: Tier:_________ and Registration #________________or Retired:_____________. (Do not report to NYS Teachers Retirement)

� I have read the information above and DO NOT wish to join the

Employees’ Retirement System. I waive my right to do so. I understand that should permanent status be granted, I must join and the current 3% employee contribution will be deducted each pay day.

_______________________________

Employee Name (please print) Social Security #

Signature of Employee Date

Department

_________________ (App # - for staff use only)

Youth Name: ____________________________________________________________

Home #: __________________________________ Date of Birth: ________________

Cell #: ____________________________________ Age: __________________

For Parent/Guardian

My child will be available for the entire 6 week YES summer employment program Yes or No

Monday, July 1st - Friday, August 9

th. I understand that if they accept a job Please circle one

and do not fulfill their 6 week obligation they will not be eligible for future summer

employment opportunities.

______________________________________ _______________

Parent/Guardian Signature Date

Job Fair Interview Request Form

Please fill out this form thoroughly and completely:

1. Review the YES Summer Classified Ads

2. Pick 3 jobs to interview for (this form will not be accepted with fewer than 3 choices)

Do not choose the position you held last summer.

3. The 3 job choices you indicate on this form will be the jobs you will interview for at the

Job Fair on Tuesday June 4th

, 3-5 PM @ The Crowne Plaza Hotel.

4. The positions that are listed from N1 – N5 will only be available for placement if

the Youth Bureau receives private funds/donations. You will still be able to

interview with the sites at the Job Fair.

Name of Employer: Name of Position Job #

Example

Planning Department_ Project Assistant_ C10

1. ________________________ __________________________ ______

2. ________________________ __________________________ ______

3. ________________________ __________________________ ______

CITY OF WHITE PLAINS YOUTH BUREAU RELEASE

1) RELEASE OF LIABILITY

In consideration of your acceptance of my child ____________________________________ for his/her participation in the activities/programs of the City of White Plains Youth Bureau, I agree that I am aware of the inherent dangers and risks involved in these activities/programs including bodily injury which may be the result of strenuous activity or other causes related to these activities/programs. I agree to release and hold harmless the City of White Plains, its officials, officers, agents, employees, and volunteers, from and against any and all liability, damage or claim of any nature arising out of or in any way related to my child’s participation in these activities/programs except those things caused by the sole negligence of the City. I understand that the City of White Plains does not provide accident or medical insurance and I am financially responsible for any and all medical expense whatsoever. I am advised to consult my child’s physician before allowing my child to participate in any strenuous activity. I have read, understand and agree with the terms of this release. Signature of parent/guardian:_____________________________________Date:____________ ************************************************************************************* I, _______________________________, as parent/guardian hereby consent that the City of White Plains may videotape/photograph my child, ___________________________________, and use the images/audio for publication/broadcast/website. I waive any claim arising against the City of White Plains from the use of such images/audio within or without the City or any other media. Signature of Parent/Guardian: Date: _________________

PARENTS’ CONSENT TO MINOR’S EMPLOYMENT AND RELINQUISHMENT TO RIGHT TO MINOR’S WAGES

State of New York ))ss:

County of Westchester)

____________________________________ and ___________________________________,

the undersigned, are the parents and the natural guardians, or the legal guardians of the person of

_____________________________, a minor, born_________________, he/she being now __________

years of age.

To enable the above-named minor to secure employment with the City of White Plains

(“Employer”), the undersigned agree that the minor may be employed by the above-named employer in

such undertaking and lines of employment and for such wages and compensation as may be agreed on by

and between the minor and the employer. The minor may do such work as such employer may call on

him/her to perform.

In consideration of the employment of ____________________________________ by The

City of White Plains, the undersigned authorize and empower the employer to pay directly to _______

___________________________________ all wages or compensation earned by him/her while in its

employ, in the same manner in which the employer pays its other employees. The undersigned release

all claims for such wages or compensation.

The purpose and intent of this agreement, as between the undersigned and The City of White

Plains, is to authorize and empower _____________________________________ to deal with such

employer in every matter connected with or arising out of his/her employment in the same manner and to

the same effect as though he/she were of lawful age.

Dated :____________________ ______________________________________

______________________________________

Sworn to before me this ______ day of

_______________, 20______.

______________________________________ Notary Public Rev. 10/09

CLASSIFIED LIST

City of White Plains Arts Position

City of White Plains Clerical Positions

MUST BE 17 YEARS OF AGE OR OLDER TO APPLY

AAGE1. Cable TV Studio TV Production Intern

1 youth, (must be 17 years of age or older) needed to assist production and office staff in running all aspects of a small production facility. Duties include production work, camera operation, directing, studio preparation, and light office work. Candidates should be eager to learn and be willing to help wherever needed. Experience is not necessary but having some technical ability and computer literacy is helpful.

C1. Budget Department Clerical Assistant

1 youth needed to perform various clerical functions including answering phones, filing, photocopying, data entry, and opening and distributing mail. Youth must have good math skills, interpersonal skills and phone skills.

C2. Building Department Clerical Assistant

4 mature, responsible youth needed to perform clerical duties which would include, scanning documents onto a computer and creating digital records, photocopying, filing and other duties as assigned. Users will be trained to perform these functions.


CAGE5. Highway Department Assistant Highway Workers

4 youth needed (must be 16 years of age or older) to assist with painting and cleaning of department equipment. Will also assist with maintenance of parks, and other tasks as assigned.

C6. Housing Authority Clerical Assistant

3 youth needed to perform basic clerical duties such as, filing, typing, making labels, and answering phones. Applicants should have basic word processing and database skills and will be asked to arrange documents according to an established system. Hours are Monday-Thursday 8-4.

C8. Parking Department Traffic Division Traffic Assistant

1 youth needed to assist engineers in the operation and maintenance of the transportation facilities. Duties will include data entry, filing surveys and taking transportation related photographs in the field to prepare AAA annual reports.


CAGE7. Mayors Office Clerical Assistant

1 youth needed to work 3 days per week (TBD). Youth must be 16 years of age or older with previous clerical experience. Duties will include interacting with the public, answering phone calls, photocopying and other tasks as assigned. Youth must be responsible, personable, reliable, able to work independently and have excellent communication skills.

C3. City Court Traffic Department

2 youth needed to work alongside court clerk in all departments. Responsibilities include data entry, filing, and general office duties. City Court is an excellent place to learn firsthand how law enforcement and the Justice system work at the local level.

C4. Clerk’s Office Assistant Clerk

1 youth needed with an outgoing personality who is good with details. Must be comfortable working with the public and must present a neat appearance. Responsibilities include answering phones, providing information, and some data entry. Accuracy is extremely important.

C9. Personnel Department Clerical Worker

1 youth needed to assist with heavy filing, light typing, moving boxes in and out of storage building as needed, assisting with mailings, answering phones, and greeting employees and members of the public.


CAGE10. Planning Department Project Assistant

1 youth, 18 years of age or older, needed to assist with a Community Housing Needs Assessment project as well as general office work. Candidate must be physically fit and eager to walk neighborhoods to assess housing stock. Great opportunity for someone interested in a career in planning, architecture, buildings and facilities, engineering, and/or construction. Candidates must be mature, detail oriented and able to work independently in a fast paced environment.

C13. Recreation & Parks Clerical Assistant

4 bilingual (Spanish/English) youth needed to assist with answering phones, registering patrons for activities, copying and general office work. Hours are Monday-Friday 9:30-2:30.

C14. White Plains Library Library Assistant (Children’s Room)

4 youth needed to shelve books, assist with craft programs, listen to children report their summer reading and prepare materials for programs.

C12. Public Works Administrative Assistant

2 youth needed to answer phones; open, sort and distribute mail; file and sometimes organize/update files. Responsibilities will also include typing, handling inquiries from residents, fielding complaints and scheduling appointments/meetings. Must have a neat, professional appearance, and excellent communication skills. Clear message taking is essential. Computer skills: typing in either WordPerfect or Microsoft Word is helpful.


CAGE11.Police Department Clerical Assistant

4 youth needed (must be 15 years of age or older) for filing, data entry, answering phones, disseminating records to the public and preparing forms and spread sheets. This is an exciting opportunity to meet and work alongside some of your local Police Officers.

C15. Youth Bureau Greeter

Bits n’ Pieces Camp 1 bilingual (Spanish/English) youth needed who is mature, responsible, well-spoken and polite to monitor the front entrance of the camp. Youth will be responsible for signing in all guests and parents entering the building as well as providing information as requested. Applicant will also be responsible for monitoring the dismissal/sign out sheets at the end of the day. Hours are Monday-Friday 9:30 to 5:30.

Must be 14-16 YEARS OF AGE TO APPLY

CAGE16. Youth Bureau Entrepreneurship Program

20 youth (14-16 years of age) needed to participate in a 6 week entrepreneurship curriculum where they will develop individualized business plans which they will present to a panel of judges. Youth will learn the basics of business development, business ethics, marketing, sales and budgeting. Business attire required. Hours are Monday-Thursday 9:30-4:00, Fridays 9-12.

Must be 18 YEARS OF AGE OR OLDER TO APPLY

CAGE17. Youth Bureau Growing White Plains Community Garden

Assistant Coordinator

1 youth, 18 years of age or older, needed to assist the program coordinator in the supervision of 12-16 year olds in a summer volunteer gardening program. Responsibilities will include signing in volunteers; working with the volunteers at 2 garden locations and other duties as assigned. Applicant must enjoy working outdoors and be mature; patient and responsible. Experience working with children is preferred. Youth will work 4 days per week. Hours are 9-1pm.


CAGE18. Youth Bureau Summer Career Academy

Workforce Preparation Program 24 youth (must be 14-16 years of age) are needed to participate in this great opportunity for those who are new to work. Youth will learn skills on how to become great employees. Youth will participate in activities that will allow them to practice living as a grownup in the real world, solving problems, finding apartments, finding jobs, and paying bills. Candidates must be willing to learn new things! Hours 9:30AM-12PM, 1:30PM- 4:00PM, Monday-Friday.

City of White Plains Summer Camps

City of White Plains Maintenance Positions

ONLY 15 YEAR OLDS CAN APPLY

SAGE1. Recreation & Parks Counselors in Training (Camp Panawok)

8 counselors needed (ONLY 15 yr. olds can apply) to work with children in a variety of environments such as gym, pool, classroom, and outdoors. Must be flexible, self-motivated, cooperative, and willing to take direction. No summer school candidates. Applicants must be available to attend orientation sessions on June 26

th and

June 27th

.

ONLY 15 YEAR OLDS CAN APPLY

SAGE2. Recreation & Parks Counselors in Training (Camp Quarropas)

6 junior counselors needed (ONLY 15 yr. olds can apply) to work with children. Must be mature and academically proficient. Must be flexible, self-motivated, cooperative, and willing to take direction. No summer school candidates. Applicants must be available to attend orientation sessions on June 26th and June 27th.


SAGE3. Youth Bureau Bits n’ Pieces Camp Assistant Counselors

8 youth (must be 16 years of age or older) needed as assistant counselors. Must be mature, patient, and have lots of energy. Responsibilities will include supervision of campers as they transition to various programs/activities, and assisting classroom instructors. Counselors will assist in the supervision of swimming pool activities, and are required to enter the pool with the children. Experience working with elementary school children is preferred.

Applicants must be available to attend mandatory orientation for Bits n’ Pieces staff on Monday, June 24

th 12:30-2:30 at Church

Street Elementary School.


SAGE4. Youth Bureau Bits n’ Pieces Camp

Head Counselors 8 youth (must be 18 years of age or older) needed as head counselors. Must be mature, patient, and have lots of energy. Responsibilities will include supervision of campers as they transition to various programs/activities, and assisting classroom instructors. Counselors will assist in the supervision of swimming pool activities, and are required to enter the pool with the children. Experience working with elementary school children is required. Applicants must be available to attend mandatory orientation for Bits n’ Pieces staff on Monday, June 24th 12:30-2:30 at Church Street Elementary School.

M2. Youth Bureau Bits n Pieces Camp

Custodian 1 youth needed to perform clean-up and maintenance duties of the camp facilities. Responsibilities will include accompanying staff to pick-up camper’s lunches at WPHS; set up of the cafeteria area and clean-up after lunch. Youth will assist with other tasks as assigned by camp director.


CAGE21. Youth Bureau Program Assistant

2 mature, responsible, college age students (must be 18 years of age or older) to work from 9:15 a.m. until 4:15 p.m. with a 1.5 hr. lunch break (5.5 hrs. total) to help supervise 24 young people employed in the Summer Career Academy which is a workforce/life preparation job site for young people 14-16 years of age. Applicants should be able to relate to and interact with young people in a positive way and also be confident enough to manage a group of 12 on their own. Must want to see young people learn and become successful. Appropriate work attire is required.

M1. White Plains Public Library Maintenance Assistant

2 youth needed to clean, paint, and garden. Must be able to lift heavy items, accept and understand directions, and work independently once task has been described. Hours 8:30am-4:30pm.


CAGE22. Youth Bureau Assistant Instructor

1 youth (must be 18 years of age or older) needed to assist with the supervision and instruction of the 20 young people employed in the Entrepreneurship Program which is a business skills development program for young people 14-16 years of age. Applicants should be able to relate to and interact with young people in a positive way. Individual must have strong math skills. This is great opportunity for those interested in going into the teaching field or interested in starting their own business. Appropriate work attire is required. Hours are Monday-Thursday 9:30-4:00 and Friday 9-12.

City of White Plains Recreational/Outdoor Positions

BE ADVISED – If you select one of the positions listed below, N1 – N6, they will only be available for placement if the Youth Bureau receives private funds/donations.

Clerical Positions

R1. Recreation & Parks Pool Pass Taker

4 youth needed to check recreation ID cards at gate, keep attendance records, and perform light maintenance duties in the pool area, park and office. Youth must be able to work until 8PM and on weekends.

R2. Recreation & Parks Scorekeeper at Kittrell Park

4 scorekeepers needed to work Monday-Thursday 4PM-8:30PM and some Fridays. Students must be clean, neat and polite and should be able to keep basketball scores. (Position is 18 hours per week).


RAGE4. Youth Bureau Greening Project

Environmental Education Program 12 youth (14-16 years of age) needed who are interested in the environment and would love to spend the summer working outdoors! Responsibilities include participating in environmental activities, gardening, and cleaning up at local parks, nature sanctuaries and preserves. Must be willing to work hard and be a team player.

R3. Recreation & Parks (Split Day Worker) Camp Maintenance Assistant

Special Events 4 youth needed who are willing to work this unique split day opportunity. Morning duties include assisting maintenance staff/and or Director with various Camp Building and Facility needs. As well as activity set-up Monday-Friday 8:00am-12:00pm. Evening duties consist of working special events in our parks. Should be dependable and be able to get to all locations. Applicants must be neat, clean, polite, and outgoing at all times. Employment is Monday- Thursday 6pm-8:30pm (hours are later on Outdoor Movie Nights)

**Applicants must be willing and able to work both the morning and evening shifts to interview for this job. Total work hours 30-35 for both AM and PM positions.

N1. Family Services of Westchester Family Center Assistant

2 youth needed to answer phones, monitor reception area, distribute incoming mail, process outgoing mail, schedule conference room, and other duties. Great opportunity for a motivated individual to observe how mental health/ social work agencies operate from the inside out.


NAGE2. New York Presbyterian Hospital Volunteer Services Assistant

4 youth needed (must be 16 years of age or older) to work in the Health Information Department, Pharmacy, Food Services, Health Information Resources Library, and general clerical offices. In all departments duties will include filing, copying, and general office work. Youth must be mature responsible, have a positive attitude, must be detail oriented and be able to follow instruction. Must complete a medical examination prior to starting. Hours 8AM- 4PM.

Must be 16 YEARS OF AGE TO APPLY

RAGE5. Youth Bureau Downtown Beautification Project

10 youth (16 years of age) needed to work outdoors throughout White Plains in projects involving painting, weeding, and clean up. Must be willing to work hard, and be outdoors for the entire work day. Hours are Monday-Friday 8:30-2:30.

Child Care Positions

Maintenance Position

N3. New York State Dept. of Labor Division of Labor Standards

Administrative Assistant 1 youth needed for filing, typing, organizing, and purging of old records. Experience using Microsoft Word is necessary.

Must be 14 OR 15 YEARS OF AGE TO APPLY

NAGE5. YWCA

Little Friends Preschool

2 counselors (14 or 15 years of age) needed with positive attitudes and good work ethic. Looking for individuals who enjoy working with young children 2-5 years old. Must be flexible and willing to take directions. Job includes outdoor and indoor play, setting up and cleaning up activities. Medical required. Hours are 8:30AM-4:00PM. Applicants will be required to work during the week of June 24th-June 28th. Applicants will be paid directly by the YWCA.


NAGE4. Family Services of Westchester Early Head Start

Classroom Aides 5 youth needed (must be 16 years of age or older) to assist in the infant, toddler and preschool classrooms. Responsibilities include playing/interacting in developmentally appropriate activities with young children, engaging in hands-on activities such as arts and crafts, music, and storybook reading; block building, and outdoor games/sports. Youth will provide warm, nurturing support to children throughout the day and assist teachers with classroom clean-up. Must be patient, kind, energetic and love children.


NAGE6. New York Presbyterian Hospital Volunteer Services Assistant

1 youth needed (must be 16 years of age or older) to work in the grounds/maintenance department. Duties will include setting up and breaking down events and assisting grounds crew in various capacities. Youth must be able to lift 20 pounds and be willing to work outdoors. Youth must be mature, responsible, have a positive attitude and be able to follow instruction. Must complete a medical examination prior to starting. Hours 8AM- 4PM.

2013 SUMMER EMPLOYMENT PACKET ~ DIRECTIONS (Read 1...

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