Apply - Central California Youth RushCentral California Youth Rush

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First & Last Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Home Phone
Cell Phone*
Date of Birth*
Month
Day
Year
Relationship Status*
Gender*

REFERENCE: Pastor's Name*
First Last
Pastor's Phone*
REFERENCE: Non-Relative*
First Last
Non-Relative Address
Street Address City State ZIP Code
Non-Relative Phone*
The following parent/guardian information is useful for us, and is required for students under 18.
Parent/Guardian Name*
First Last
Additional Parent/Guardian Name
First Last
Parent/Guardian's E-mail*
Additional Parent/Guardian's E-mail
Parent/Guardian Address*
Street Address City State ZIP Code
Parent/Guardian Phone*
Additional Parent/Guardian Phone*
Have you ever been disciplined for actions which violate Seventh-day Adventist standards/principles, or for anything illegal? If yes, please explain.*
I understand that the employer will thoroughly investigate my work and personal history and verify all data given on this application, on related papers, and in interviews. I authorize all individuals, schools, and firms named therein to provide any information requested about me, and I release them from all liability for damage in providing this information. I understand that withholding information or falsifying information requested on this application is grounds for immediate termination.*
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