Application

Learn and Earn Summer Youth Employment Application

= Required Information

1. First Name

2. Last Name

3. Preferred First Name

4. Birthdate7/2/2025

5. Social Security Number

6. Youth's Email

7. Home Phone

8. Cell Phone

9. Parent/Guardian Name

10. Parent/Guardian Phone

11. Alternate Email (Parent/Guardian)

12. What is the best phone number to reach you?

13. Are you currently married?

14. Are you (the youth applicant) currently parenting one or more children? (This does not apply if you are currently pregnant and have no other children)

15. Who is completing this application?

16. Street Address

17. Mailing City

18. Mailing State

19. Mailing Zip/Postal Code

20. Are you currently in school?

21. School district you attend or most recently attended

22. Are you currently employed?

23. Are you involved in any year-round employment or training programs?

24. How many family members are living in your household, including yourself?0

25. Please list the full names of your household members and their relationship to you (ex: Jane Doe, grandmother, John Doe, brother, etc.)

26. What was your household’s total gross (pre-tax) income for the last 6 months?$0.00

27. Applicant last month income

28. Have you lived in any of the following situations in the past 6 months? Choose any that apply. (Double click to add to list.)

29. Did you or anyone in your immediate family receive TANF (Public Assistance) in the past 6 months?

30. Did you or anyone in your immediate family receive Food Stamps in the past 6 months?

31. Are you an unaccompanied youth who is homeless or self-supporting and at risk of being homeless?

32. Are you in foster care or aging out of foster care?

33. Did you participate in Learn & Earn before?

34. Is there a Learn & Earn organization you wish to work with this year?

35. Do you have a member of your household that you would prefer to be placed with? If so, please list them here.

36. Career Track - Priority 1

37. Career Track - Priority 2

38. Please select the job opportunity or opportunities listed below that you are interested in. Choose any that apply. (Double click to add to list.)

39. Do you have a driver's license?

40. How will you most often travel to and from work?

41. If you would like to work in a Pittsburgh city neighborhood, what is your preference? (This will be taken into consideration but is not a guarantee of placement.)

42. Are you able to work outdoors for extended periods of time (more than 1 hour)?

43. Which Application Support Center did you visit to get assistance with the application?

44. How did you hear about Learn & Earn?

45. I would like to receive emails about future training and employment opportunities. I grant permission for my email address to be shared with official partners of the Partner4Work (TRWIB, Inc.).

Demographic Information

EEO STATEMENT

We are an Equal Employment Opportunity employer, and do not discriminate in our hiring or employment practices. All qualified applicants will receive consideration without regard to race, color, creed, religion, national origin, age, disability, sex, or any other characteristic protected by State or Federal law.

46. What word(s) best describe your race?

47. Are you of Hispanic, Latino or Spanish origin?

48. What word or phrase best describes your gender?

49. Do you have a disability?

50. If yes, do you have an IEP or 504 plan?

51. English Proficiency

52. Are you a U.S. Citizen?

53. Authorized to work

54. Are you registered with Selective Service? (All males 18 and older must register with selective service, please refer to www.sss.gov for assistance)

55. Covid Vaccination Status

Skills

Add New Skill	Skill

Work Experience

Add New Work	Employer Name	Type of Job	Weekly Hours	Hourly Wage	Started	Ended

Attachments

All documents with an * are REQUIRED to submit your application.
Please note that PROOF OF ADDRESS and PROOF OF INCOME must be updated each year that you apply.

Proof of Address: MUST BE DATED 9/11/2020 OR LATER.
Acceptable documents: Home Utility Bill, Current Lease, Postmarked mail with Applicant’s name and address, Report Card, Department of Public Welfare Printout, PA Driver’s License or State ID
*Proof of Income: MUST BE DATED 9/11/2020 OR LATER.
This must reflect total household income.
Acceptable documents:
• Pay stubs of all household members with date and year-to-date amounts
• Public Assistance Printout or Notification
• Social Security Letter
• SSI Letter of Notification of benefits
• Unemployment compensation information or determination letter
• Statement from a foster placement agency
• Letter from social service agency or other institution describing the applicant’s living arrangements and income statement of income
• Income eligibility determination from a public or government agency
PLEASE NOTE: If uploading a pay stubs you will only need ONE paystub issued during the previous 6 month period for each household member giving a pay stub. Multiple pay stubs from the same job are not needed.
*Proof of Age
Acceptable documents: Birth Certificate, Passport, Permanent Residency Card, Employment Authorization document, or Certificate of Citizenship or Naturalization
*Proof of Citizenship/Alien Status
Acceptable documents: Valid U.S. Birth Certificate, U.S. Passport, Permanent Residency Card, Employment Authorization document, or Certificate of Naturalization or Citizenship
PLEASE NOTE: A Social Security Card is NOT a valid form of citizenship.
*Proof of Social Security
Acceptable documents: Social Security Card
Resume
Required if you selected Corporate Internship as one of your Learning Goal Priorities in questions 34, 35 or 36.
Selective Service Registration
Required for male applicants 18 years and older
Please click here to verify your selective service registration.
Please click here to register for the first time.
Work permits are not required as part of the application. However, if you are selected for job placement and under the age of 18 at any point during the program, you will need a work permit in order to participate in Learn & Earn.
If you already have one, we encourage you to upload the permit in this section. Youth will need to contact their home school district to learn how to get a Work Permit. If you go to a private or charter school, or if you are homeschooled or not in school, you still need to contact your home school district. Information for Pittsburgh Public Schools can be found here.

Please click the blue button below to begin uploading documents.

Add New Attachment	Name	Description	Type	View

Save or Submit Application

Please Click 'Save Progress' if you would like to save your work and continue the application at a later time. Please note: to Save Progress, all required fields must be completed first.

All Application Questions and Demographic Fields are Required to Submit the Application for Learn and Earn Summer Youth Employment. In addition, the following documents must be uploaded in the 'Attachments' area before submitting:

Proof of Age
Proof of Social Security
Proof of Citizenship
Proof of Address
Proof of Income
Selective Service Registration (only for male applicants 18 years and older)

I verify that all of the information provided in this application is accurate. In signing this application, I give permission for the following:
My full application information will be shared with my Learn and Earn provider, the City of Pittsburgh and/or Allegheny County for enrollment and record-keeping purposes.
How will I know the status of my application?

• Log back in and at bottom of the page you will see the status of your application.
o Incomplete = there is missing information from your application and it has not yet been submitted for review
o Submitted = the application is currently under review
o Approved = you are eligible for the application and on the waiting list for a job placement. This does not guarantee a job placement.

• Pay attention to your email and phone!
o You will receive emails or phone calls or text messages with updates on your application status. We will contact the emails and phone numbers submitted in this application. If your phone number or email has changed, please contact Learn and Earn to inform: (412) 932-2950.
o Remember to check your spam or junk folder