Leaders: there are many details - for questions, ask Misha Leyer or David Backer.
** Complete and submit these to David Backer by March 13th, 2021. **

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City of Newton Employment forms
Download these files, print them out, and fill in the forms - a total of nine (9) pages if you are over 18, OR eleven (11) pages if you are under 18 (links open in new window). All links are underlined.

For 2021, use the following PDF files:

1. Job Application Form, 2 pages; for "Position desired" put Counselor, Environmental Science Program; you sign page 2

2. CORI Request form, 2 pages; requires last 6 digits of Social Security Number, you sign page 1.

3. Form I-9 (Employment Eligibility Verification)
2 pages. See notes below, especially the identification requirements.

4. Form W-4, Withholding Allowance Certificate
1 page. See notes below.

5. M-4, Massachusetts With-holding form
1 page. See notes below.

6. VOYA Financial Enrollment Form, 1 page; (for your employee retirement account) you sign middle of page. If you already have an account set up (if you are a returning leader who did not request funds) you do NOT need to fill this out again.

Notes:

• For the Form I-9: fill in pages 1 and 2; this form requires Identification: either a photocopy of your passport, OR, a copy of your driver's license AND an ID card such as a school ID; you sign in Section 1, at "Signature of Employee"

• For the Form W-4, Withholding Allowance Certificate, 1 page; you sign and date below line 7.

• For the Form M-4, Massachusetts Withholding Certificate, 1 page; you sign and date.

 

All these employment forms must be submitted to the City of Newton through David Backer. Please coordinate a time to meet if you have questions (617-682-5693).

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Only for leaders 14 - 17 years old: State Employment Permit Form,
2 pages. David Backer signs bottom of page 1; parent, guardian, or custodian signs in section 4, leader signs section 5 (bottom of page 2), from your school office. Contact the school you attend and ask the office how they issue you a work permit.

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HeadsUp training course

You also need to complete the online "HeadsUp" training course on concussions:
https://www.cdc.gov/headsup/youthsports/training/index.html

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Leader health and permission forms (for leaders under 18):

If you are under 18, download these files, print them out, and fill in the forms - total of six (6) pages (links open in new window):

• Consent Form / Release from Liability (1 page)

• Photo/Video release form (1 page)

• ESP Immunization Record (Staff & Students under 18) + Special Activities Permission Form (3 pages)

• Authorization to administer medication to a camper form + signature page (1 page)

You also need to send in a Physicians examination form before the start of the program, which your physician can provide.

Mail or give the completed forms to David Backer, Executive Director

Thanks.

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Leader health and permission forms (for leaders over 18):

If you are over 18, download these files, print them out, and fill in the forms - total of five (5) pages (links open in new window):

• Consent Form / Release from Liability (1 page)

• Photo/Video release form (1 page)

• ESP Immunization Record (Staff over 18) + Special Activities Permission Form (3 pages)

You also need to send in a Physicians examination form before the start of the program, which your physician can provide.

Mail or give the completed forms to David Backer, Executive Director

Thanks.