Date Received ___________
Interview Date: __________
Harbor House Ministries
Youth Leadership Program Intern Application
1811 Eleventh Avenue, Oakland, CA 94606 – (510) 534-0165 – www.hhministries.org
This position is designed for high school-aged youth and students in junior college who want to help create positive
change in the lives of young people in our community.
Personal information
Name: ________________________________________________________________________________________
(Last)
(First)
(Middle Initial)
Home address: _________________________________________________________________________________
(Street)
(Apt. #)
_____________________________________________________________________________________________
(City)
(Zip code)
Home phone: _______________________________
Cell phone: _____________________________________
Email: _________________________________________________________
Gender (M/F): ________
Birth date: ________________ __ Highest Level of School Completed: ____________
Current school : _____________________________________
Have you applied for YLP before? ____________
Parent or guardian’s full name(s): __________________________________________________________________
Parent or guardian’s phone number(s): _____________________________________________________________
Emergency contact: _____________________________________________________________________________
(Name)
(Relation)
(Phone number)
Skills and interests assessment
For this section, number from 1 to 5 (five being the highest) your level of interest in leading the following activities:
Coaching sports:
_______
Sport: ____________________
Cooking:
_______
Drawing/painting:
_______
Dance:
_______
Graffiti art:
_______
Theatre/acting:
_______
Bible studies:
_______
Music/singing:
_______
Writing:
_______
Carpentry:
_______
Gardening:
_______
Community service:
_______
Office work:
_______
Arts and crafts:
_______
Other skills or activity ideas: ______________________________________________________________________
Date Received ___________
Interview Date: __________
Short Answer Questions
These questions are designed to assess the applicant’s suitability for the Youth Leadership Program. Please
answer the following questions in a thoughtful and complete manner.
1. Why do you want to be a part of the Youth Leadership Program?
2. What strengths and skills do you have that make you a strong candidate for this position?
3. What are some of your weaknesses and how are you working to improve them?
4. Summarize any previous work experience you have, including dates (year) and duties performed.
Date Received ___________
Interview Date: __________
5. What are some of your interests & hobbies? What activities could you see yourself leading here?
6. What is the one accomplishment that you are most proud of? How did it make you feel about
yourself?
7. What are your goals for the immediate future, and what are your goals for the next few years?
8. How would your friends describe you?
Date Received ___________
Interview Date: __________
Harbor House Ministries, Inc.
2012 Youth Program Staff Information
Job description for Harbor House Summer Youth Leadership Program Internship
Overview
The Harbor House Youth Leadership Program is designed to help Oakland youth become leaders who will
create positive change in their own local communities. We recognize that while high school youth and young
adults are natural leaders in their neighborhoods, they are often disadvantaged by an absence of direction,
opportunity, and mentors who will help them grow. At Harbor House, we seek to offer our love and guidance
to these youth, and give them opportunities for skill development, spiritual growth, and financial
advancement.
Duties and Responsibilities
First and foremost, Harbor House interns are responsible for loving and caring for the young people in our
programs. Interns at Harbor House will be entrusted to set a positive example for our kids in everything they
do. Internship duties place an emphasis on serving as leaders for our activities, which include a variety of
sports, cooking, art, field trips, and cleaning up the facility. In addition, Harbor House interns are expected to
encourage program participants towards good behavior, while also offering appropriate discipline for poor
behavior.
Hours + Stipend
All potential interns must begin with a 2-3 week volunteer period. This will allow the applicant and Harbor
House staff time to evaluate if it will be a good fit.
If, after the volunteer period is over, it is determined the intern will be a good fit for the youth program, the
applicant then becomes a Harbor House Intern.
Work Hours are 3:00 (or directly after school) – 6:00, Monday, Tuesday, Thursday & Friday
1:15 (or directly after school) – 6:00, Wednesday. This is a minimum day and the students
arrive early. From 5 – 6pm there is a Youth Department staff meeting.
Every other Friday there is no program for the students, but there is staff development/training from 45:30pm.
All Interns begin at a monthly stipend of $100/month. Stipends are evaluated regularly and increase given
when the Interns demonstrates merit for the increase.
Harbor House interns are expected to be at work every day that Harbor House is in session. In the event that
an intern cannot be present for work on a given day, the intern is expected to notify Harbor House staff at
least 24 hours before the start of the next program day. Excessive absences or tardiness will result in
disciplinary action.
Date Received ___________
Interview Date: __________
Conduct
Harbor House interns are expected to demonstrate good character for our youth in all situations. While most
of these should be common-sense, we will not tolerate any of the following actions from our interns:
-
Lying to Harbor House staff/volunteers
Fighting or teasing program participants or other interns/staff
Drug or alcohol use
Missing work or staff meetings and functions without prior notice and clearance with staff
Use of improper language (under any circumstance)
Using cell phones, iPods or other electronic devices during program
Poor attitude or unwillingness to learn
Any of the above conduct can result in suspension without pay, and/or termination from the YLP program.
__________________________________________________________________________________________
__________________________________________________________________________________________
______________________________________________________
Please sign and date to indicate that you agree to the terms outlined above:
Applicant’s signature: __________________________________________ Date: _________________
Parent/Guardian’s signature: ____________________________________ Date: _________________
(if under 18 years of age)
Parent/Guardian’s phone number: ____________________________________
8.2012
Date Received ___________
Interview Date: __________
EMPLOYEE EMERGENCY NOTIFICATION
IN CASE OF ILLNESS OR ACCIDENT, NOTIFY
Name: ___________________________________ Relationship (optional): ________________________
Address: _____________________________________________________________________________
Telephone: Home _____________________ Office ____________________ Cell _________________
Medical Insurance Provided: _____________________________________________________________
Name: ___________________________________ Relationship (optional): ________________________
Address: _____________________________________________________________________________
Telephone: Home _____________________ Office ____________________ Cell _________________
Medical Insurance Provided: _____________________________________________________________
Medical Information
Name of Doctor or Clinic: _______________________________________________________________
Address: ___________________________________________ Phone Number:
Health Insurance Carrier:
Plan#
Subscriber Name and Number:
List any allergies, dietary restrictions, or physical handicaps:
List any medications:
____________
______________
______________