Form ES326 "New York Youth Jobs Program: Youth Certification" - New York

What Is Form ES326?

This is a legal form that was released by the New York State Department of Labor - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2020;
  • The latest edition provided by the New York State Department of Labor;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ES326 by clicking the link below or browse more documents and templates provided by the New York State Department of Labor.

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Download Form ES326 "New York Youth Jobs Program: Youth Certification" - New York

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New York Youth Jobs Program
Harriman State Office Campus
Building 12, Room 412
Albany, NY 12240
New York Youth Jobs Program: 2020 Youth Certification
Use this form to apply for 2019 youth certification in the New York Youth Jobs Program.
The applicant (you), must complete all items: one through eighteen, except item 11. Item 11 is optional.
If you are 16 or 17 years old your parent or guardian must sign and submit the application for you.
If you have little or no access to a computer, mail the completed and signed application to the address above
or fax it to (518) 485-1359. We do not accept applications submitted for you by a business or tax consultant.
If you have questions or need help, please call (877) 226-5724 or email info@youthworks.ny.gov.
1. Last name:
First name:
Middle initial:
2. Birth date (mm/dd/yyyy):
3. Social Security Number:
4. Home address:
5. City:
6. State:
7. Zip:
8. I currently live in the town, or city limits, of the following target area, check one:
Albany
Brookhaven
Buffalo
Hempstead
Mount Vernon
New Rochelle
New York City (5 boroughs)
Rochester
Schenectady
Syracuse
Utica
White Plains
Yonkers
Any Other Area:
9: Email:
10. Main phone:
11. Other phone (optional):
12. a. I am currently attending high school
Yes
No
b. I am currently enrolled in a High School Equivalency (HSE) program
Yes
No
13. Are any of the following four statements true?
Yes
No
a. I am currently unemployed.
b. I was unemployed prior to completing this application.
c. I do not have enough paid work.
d. The work I have does not make use of my skills and training.
14. I am 16 or 17 years old. I have my parent’s or guardian’s permission to submit this application
Yes
No
If ‘Yes,’ complete items a through c.
a. Parent/Guardian First name:
b.
Last name:
c.
Phone:
15. I have working papers
Yes
No
16. a. I am 18 to 24 years old
Yes
No
b. Are any of the following five statements true?
Yes
No
I have a high school diploma.
I have a General Education Development diploma (GED).
I have High School Equivalency (HSE) diploma.
I have satisfactorily completed a Test for Assessing Secondary Completion (TASC) exam.
I am enrolled in a Treatment Accountability for Safer Communities (TASC) program.
17. I would like the Department of Labor to contact me by
Phone or
Email
Note: Unless you choose phone, we will use your email for more efficient communication.
ES 326 (06/20)
Page 1 of 2
New York Youth Jobs Program
Harriman State Office Campus
Building 12, Room 412
Albany, NY 12240
New York Youth Jobs Program: 2020 Youth Certification
Use this form to apply for 2019 youth certification in the New York Youth Jobs Program.
The applicant (you), must complete all items: one through eighteen, except item 11. Item 11 is optional.
If you are 16 or 17 years old your parent or guardian must sign and submit the application for you.
If you have little or no access to a computer, mail the completed and signed application to the address above
or fax it to (518) 485-1359. We do not accept applications submitted for you by a business or tax consultant.
If you have questions or need help, please call (877) 226-5724 or email info@youthworks.ny.gov.
1. Last name:
First name:
Middle initial:
2. Birth date (mm/dd/yyyy):
3. Social Security Number:
4. Home address:
5. City:
6. State:
7. Zip:
8. I currently live in the town, or city limits, of the following target area, check one:
Albany
Brookhaven
Buffalo
Hempstead
Mount Vernon
New Rochelle
New York City (5 boroughs)
Rochester
Schenectady
Syracuse
Utica
White Plains
Yonkers
Any Other Area:
9: Email:
10. Main phone:
11. Other phone (optional):
12. a. I am currently attending high school
Yes
No
b. I am currently enrolled in a High School Equivalency (HSE) program
Yes
No
13. Are any of the following four statements true?
Yes
No
a. I am currently unemployed.
b. I was unemployed prior to completing this application.
c. I do not have enough paid work.
d. The work I have does not make use of my skills and training.
14. I am 16 or 17 years old. I have my parent’s or guardian’s permission to submit this application
Yes
No
If ‘Yes,’ complete items a through c.
a. Parent/Guardian First name:
b.
Last name:
c.
Phone:
15. I have working papers
Yes
No
16. a. I am 18 to 24 years old
Yes
No
b. Are any of the following five statements true?
Yes
No
I have a high school diploma.
I have a General Education Development diploma (GED).
I have High School Equivalency (HSE) diploma.
I have satisfactorily completed a Test for Assessing Secondary Completion (TASC) exam.
I am enrolled in a Treatment Accountability for Safer Communities (TASC) program.
17. I would like the Department of Labor to contact me by
Phone or
Email
Note: Unless you choose phone, we will use your email for more efficient communication.
ES 326 (06/20)
Page 1 of 2
New York Youth Jobs Program: 2019 Youth Certification Qualifications:
To participate in the New York Youth Jobs Program:
You must be 16 to 24 years old, and
You must live in one of the target areas of New York State listed in item nine on page one, and
You must be unemployed, and
At least one of the following statements must apply to you:
o
I am over 18 years of age and do not have a high school diploma or a General Educational
Development (GED) or High School Equivalency (HSE) diploma.
o
I am a member of a family that is receiving:
Assistance from Temporary Assistance for Needy Families (TANF).
Supplemental Nutrition Assistance Program (SNAP) benefits (food stamps).
Social Security Income (SSI) benefits.
o
I am receiving a free or reduced-cost school lunch.
o
I was referred to this program by a rehabilitation agency approved by the state, or an
employment network under the Ticket to Work Program.
o
I have served time in jail or prison or I am on probation or parole.
o
I am pregnant or a parent.
o
I am homeless.
o
I am currently or was in foster care or the custody of the Office of Children and Family Services.
o
I am a veteran.
o
I am the daughter or son of a parent who is currently in jail or prison, or was in jail or prison within
the past two years.
o
I am the daughter or son of a parent who is collecting unemployment insurance.
o
I live in public housing or receive housing assistance such as a Section 8 voucher.
o
I have another risk factor not identified above
18. Agreement:
I swear that I currently meet the qualifications listed above in the New York Youth Jobs Program: 2019
Youth Certification Qualifications section.
I understand that I must provide private, personal information on this application to qualify for the program.
I understand that I do not need to explain why I qualify to anyone I ask for a job, or who gives me a job, or
anyone who I work with.
I agree to allow the New York State Department of Taxation and Finance to share my wage record with the
New York State Department of Labor.
I believe the information submitted in this application is true, correct and complete.
I understand that the New York State Department of Labor will make sure the information submitted in this
application is true and may ask me for more information or details.
I am aware that there are consequences for filing false documents or other information with the government.
I agree to the statements above.
a. Signature (If you are under 18, your parent or guardian must sign):
b. Date:
c. Print name:
d. Note: Please be sure to add info@youthworks.ny.gov to your list of email contacts to ensure you receive your
certificate by email.
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