Shenendehowa High School Counseling Center

Working papers are required until a student is 18 years old.
To download the Application for Employment Certificate AT-17, go to this website: www.emsc.nysed.gov/sss/PupilServices

• Part I – Parental Consent:  Please fill in student’s name, age, social security number and address.  Parent/legal guardian must sign this section.

• Part II – Evidence of Age:  Student will need to bring proof of age (i.e. copy of birth certificate, passport, driver’s license, etc.).

• Part III – Certificate of Physical Fitness:  Student will need to take application to the school nurse for verification of a physical exam.  Said exam must have been given within the last twelve months.  The school nurse will verify and sign Part III.  If you do not have a physical exam on file, the nurse will be unable to complete this section until one is provided.  *Note:  When school is not in session, attach a copy of the physical exam signed by your physician or a Certificate of Physical Fitness form from your physician’s office to the application form.

• Parts IV, V, VI – Leave these parts blank.

Once Part 1 is completed and Part 3 signed by the school nurse, bring the application form, along with evidence of age, to the Counseling Center for processing.  Completed applications dropped off before noon may be picked up at the end of the day.  Applications dropped off after noon may be picked up at the end of the following day.

*NOTE:   During the summer, completed applications may be dropped off at the Counseling Center between 8:00 A.M. and 12:00 noon Monday through Wednesday. Please allow 24 hours for your application to be processed.