APPLICATION FORM:    Return at school. OR MAIL TO THE OFFICE. (see contract page #2)

NAME: _____________________________________________________
ADDRESS:________________________________________________ APT._____
email:____________________________   Cellphone: ____________________

POSTAL CODE: _______ PHONE NUMBER:_____________

SCHOOL:_________________ GRADE/YEAR: ____ BIRTHDATE: D/M/Y _________

Language(s) spoken fluently (besides English!) __________________________________

JOB INTERESTS (Please check)
Light Housekeeping**____ Gardening**___ Errands __ Odd Jobs _____ Snow Shovelling __ Letter Writing _  Shopping __  Painting _  Basic Computer Instruction __  Other ________

Would you like the jobs to be close to Home ___ or School ___
( ** If you have checked these categories, please describe the duties you are willing to do, and the experience you have.)
________________________________________________________________________


TWO REFERENCES ARE NEEDED - Adults who are not relatives. One should be a teacher or other school contact.

I recommend this student as an honest and reliable person to work around senior citizens' homes.

NAME: _______________________  SIGNATURE:______________________
ADDRESS/SCHOOL: ____________________________________
PHONE: (Home) ______________ (Business) ___________________

NAME: ______________________ SIGNATURE: ___________________
ADDRESS/SCHOOL:___________________________________________
PHONE:(Home) ______________ (Business) ___________________


I have read the SAINTS Student Contract and agree to abide by the guidelines outlined therein. I understand that if I cannot fulfill my obligation to a client, I will inform them and/or the SAINTS office as soon as possible. I understand that during the course of my job I will learn information concerning the clients I am serving. In order to preserve the trust and privacy of the client, I promise that all information will be kept confidential.

STUDENT'S SIGNATURE ___________________ DATE:________ 1