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Shenendehowa High School Counseling Center
Application for Employment Certificate
(Working Card)
Part I – Parental Consent:
Please fill in student’s name, age, social
security number and address. Parent/legal guardian must sign this section.
- Part II – Evidence of Age
:
Student will need to bring proof of age (i.e. copy of
birth certificate, passport, driver’s license, etc.).
- Part III –
Certificate of Physical Fitness:
Student will need to take application to the school nurse for
verification of a physical exam. Said exam must have been given within the
last twelve months. The school nurse will verify and sign Part III. If you
do not have a physical exam on file, the nurse will be unable to complete
this section until one is provided. *Note: When school is not in
session, attach a copy of the physical exam signed by your physician or a
Certificate of Physical Fitness form from your physician’s
office to the application form.
- Parts IV, V, VI –
Leave these parts blank.
Once Part 1 is completed and Part 3 signed by
the school nurse, bring the application form, along with evidence of age,
to the Counseling Center for processing. Completed applications
dropped off before noon may be picked up at the end of the day. Applications
dropped off after noon may be picked up at the end of the following day.
*NOTE: During the summer, completed
applications may be dropped off at the Counseling Center between 8:00 A.M.
and 12:00 noon Monday through Friday. Please allow 24 hours for your
application to be processed.
W Work Card Instructions
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