PFS Summer Youth 2025 Application

Work History

Labor Force Status: Please check your status and complete the information below
Are you currently employed?*

YesNo
Are you currently receiving unemployment benefits?*

YesNo
Number of weeks on unemployment
Complete the information below for the last two jobs you have held. Start with the most recent position. Include Military and Volunteer work.
Job Title
Dates of employment:

MonthDayYear
From
MonthDayYear
To
Company
Supervisor
Phone
Address

Address

Street Address Line 2

CityState

Zip
Hours/Week
Hourly wage
Reason for leaving
Job Title
Dates of employment:

MonthDayYear
From
MonthDayYear
To
Company
Supervisor
Phone
Address

Address

Street Address Line 2

CityState

Zip
Hours/Week
Hourly wage
Reason for leaving
Certification of Applicant:
I certify that the information provided is true to the best of my knowledge. I am aware that the information provided is sub ject to review and verification and that I may have to provide additional information. I authorize Partners to share this information with Partners For Success Partners (ie. Tribal Court, L-A High School, LA Connections, Employment & Training, PFS Higher Ed., Grants Cibola County Schools) for the purpose of assisting me in obtaining assistance, training, education or employment.
Applicant's Signature*

Clear
Date

MonthDayYear
Parent/Guardian's Signature

Clear
Date

MonthDayYear

W-9 Tax Form

Request for Taxpayer Identification Number and Certification
Your Full Name*
Click the checkbox below*

Individual/Sole Proprietor
Address*

(Number, Street)

Street Address Line 2

CityState / Province

Postal / Zip Code
City, State, Zip Code*

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number

Type each individual digit into the seven separate boxes below (no dashes)
Signature*

Clear
Today's Date*

MonthDayYear

Media Release Form

PFS may take photo and/or video of participants for promotional purposes.
I, TYPE YOUR NAME* , do hereby grant permission to the Laguna Department of Education-Partners for Success to Photograph, Video Record, Audio Record me and use the images, my name and sounds obtained for print, radio, electronic media, websites or video broadcasts anywhere throughout the United States and to edit such media for the sole purpose of promoting Partners for Success.

I hereby attest that I have read and agree to the above statement.
Signature*

Clear
Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone*
Please enter your home phone number
Cell Phone*
Please enter your cell phone number
Email Address*
username@company.com
If you are under the age of 18 years of age, the signature of Parent/Guardian is also
required:
Parent/Guardian Name
Parent/Guardian Signature

Clear
Date

MonthDayYear

Tribal Background Check

Summer 2025
I give permission for the Laguna Department of Education to proceed with the Pueblo of Laguna background check for pre-employment purposes for the Partners for Success Youth Employment Program.
Parent/Guardian Signature

Clear
Date

MonthDayYear
18 and older, the signature of Parent/Guardian is not required.
Youth Signature*

Clear
Date*

MonthDayYear

Release of Background Information

Summer 2025
I give permission for the Laguna Department of Education - Human Resources department to Release Background Information, which will include Quest Diagnostics Drug Test and POL Tribal Police Background Check results regarding myself or my child who will be employed with the Partners for Success Youth Employment Program to the Pueblo of Laguna - HR department or Laguna Rainbow Corp.
Parent/Guardian Signature

Clear
Date

MonthDayYear
18 and older, the signature of Parent/Guardian is not required.
Youth Signature*

Clear
Date*

MonthDayYear

Affidavit for PFS Youth Employment

NOTE: This section is to be filled out by applicants OVER the age of 18 (click "Next" below if not applicable to you)
I, being duly sworn, hereby deposes and says;
1. I am over the age of 18 and I am a resident and tribal member of the
  Pueblo of Laguna, New Mexico. I have personal knowledge of the facts
  herein, if called as a witness, could testify completely thereto.
2. I do not receive financial support, social security, nor personal income to
  the best of my knowledge.
I declare that, to the best of my knowledge and belief, the information is true, correct and complete.
Your Full Name
Today's Date

MonthDayYear
Your Signature

Clear

NEW MEXICO WORK PERMIT FOR UNDER 16

This section is for applicants UNDER the age of 16 (click "Submit" below if not applicable to you)
Applicant's Full Legal Name
Applicant's Date of Birth

MonthDayYear
DOB
Applicant's Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant's Email Address
example@example.com
Applicant's Signature

Clear
Parent/Guardian's Email Address
example@example.com
Parent/Guardian's Signature

Clear
Should be Empty:

PFS Youth Employment/Internships