Forms • Derby, KS • CivicEngage

Seasonal Grounds Application-Youth

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First Name*

Last Name

Street Address

City

State

Zip Code

Phone Number

Email Address

Are you at least 16 years old?

Yes

Please describe your desired schedule, in detail (Typical schedule is M-F 7:00 a.m.-3:30 p.m. with a 30-minute lunch). Keep in mind summer camps, planned vacation, daily practices, etc.

Please describe your experience in groundskeeping (mowing, weed-eating, etc.)

Have you ever been convicted of a crime, other than a minor traffic citation? If so, please explain.Otherwise, respond "No".*

* indicates required fields.

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