Intern & Earn Forms

SCD 2521

The “Intern & Earn Checklist” (SCD 2521) is used as a guideline to ensure that all appropriate documents are obtained.

SCD 2526

The “Intern & Earn Participant Application” (SCD 2526) is completed by the youth.

SCD 2527

“Intern & Earn Time Sheet” (SCD 2527) is completed bi-weekly by the youth and worksite supervisor.

SCD 2528

The youth is required to complete the “Intern & Earn Payday Acknowledgment of Pay Schedule” (SCD 2528) to acknowledge accurate the requirement to accurately track and complete work hours on the timesheet.

SCD 197

The “Confidentiality Agreement” (SCD 197) is required to be completed by the youth to acknowledge that any confidential information encountered in the course of the job assignment must be kept confidential.

SCD 2529

The “Client Emergency Information Card” (SCD 2529) is used to collect youth’s emergency contact information.

SCD 2538

“EC Works Program Authorized Representative” (SCD 2538) is used to obtain name, title and email address of authorized representative(s) who will oversee youth and sign timesheets.

Pre-designation of Personal Physician Form

Refer to Workers Compensation Pre-designation form.

Note: Path to SSA form’s Library: https://ssaconnect.sccgov.org/ssaforms/Pages/default.aspx

Media Release Form

Refer to Media Release form.

Note: Path to AO policy/forms: https://ssaconnect.sccgov.org/AO/Pages/home.aspx