Page 94 - Juvenile Practice is not Child's Play

Present and prior employment, including summer jobs and part-time jobs) (separate notation of all employers if
more than one):
Name of employer:
Street address: Phone:

Email, e-text, and website addresses:
Type of business:

Narrative description of what the client does in the usual course of his or her work:
Hours and days of work:

Period of employment:

Reason employment terminated if client is not still employed in this job:

Social security number: XXX-XX-XXXX

Client’s father:
Name:

Type of work:

Living Deceased

If living: Age:

Street address: Phone:

Email, e-text, and website addresses

Employed: Yes No

Employer’s name:

Employer’s street address:

Employer’s phone:

Employer’s email, e-text, and website addresses

Narrative description of what father does in the usual course of his work:

Client’s mother:

Name:
Type of work: