Spouse

Name

Available Shift - Please check which shift(s) you will be available to be assigned to work. Unless you tell us otherwise, you will be assigned to 1 shift.

Restrictions: List any restrictions or accommodations needed.

Child 1 (If child is a KCSS student they do not need to pay to work a second shift after school)

Name       Age: Adult (18+)     Teen (13 - 17)      Youth (6-12)

Available Shift - Please check which shift(s) you will be available to be assigned to work. Unless you tell us otherwise, you will be assigned to 1 shift.

Restrictions: List any restrictions or accommodations needed.

Child 2 (If child is a KCSS student they do not need to pay to work a second shift after school)

Name       Age: Adult (18+)     Teen (13 - 17)      Youth (6-12)

Available Shift - Please check which shift(s) you will be available to be assigned to work. Unless you tell us otherwise, you will be assigned to 1 shift.

Restrictions: List any restrictions or accommodations needed.

Child 3 (If child is a KCSS student they do not need to pay to work a second shift after school)

Name       Age: Adult (18+)     Teen (13 - 17)      Youth (6-12)

Available Shift - Please check which shift(s) you will be available to be assigned to work. Unless you tell us otherwise, you will be assigned to 1 shift.

Restrictions: List any restrictions or accommodations needed.

Child 4 (If child is a KCSS student they do not need to pay to work a second shift after school)

Name       Age: Adult (18+)     Teen (13 - 17)      Youth (6-12)

Available Shift - Please check which shift(s) you will be available to be assigned to work. Unless you tell us otherwise, you will be assigned to 1 shift.

Restrictions: List any restrictions or accommodations needed.

Child 5 (If child is a KCSS student they do not need to pay to work a second shift after school)

Name       Age: Adult (18+)     Teen (13 - 17)      Youth (6-12)

Available Shift - Please check which shift(s) you will be available to be assigned to work. Unless you tell us otherwise, you will be assigned to 1 shift.

Restrictions: List any restrictions or accommodations needed.