How do I complete the forms?

Complete section I & II on the AT-17 Application for Employment Certificate (highlighted areas) which require: 

  • Part I: Including the signature of your parent or guardian
  • Part II: Date of birth NOTE: If you DO NOT attend Iroquois High School, you will need your birth certificate, passport or driver's license for proof of birth date 

Complete the top section on the AT-16 Physical Fitness Certification form (Name, address, date of birth) and have your physician or the school nurse complete Section A (Instructions to Healthcare Provider) indicating that you have had a physical within the last 12 months.

The application forms (AT-17 Application for Employment Certificate and AT-16 Physical Fitness Certification) can either be picked up in the Student Support Services office or the form can be downloaded from the Student Support Services web page. Students can return the completed form to the Student Support Services Office for processing OR they can email the completed form to Mrs. Olsen at 

It is important to note that a student must have a physical dated within the past year when applying per NYSED regulations. The student will either have an updated physical on file with the school health office, or must have a signature from physician's office on the AT-16 Physical Fitness Certification (under "Instructions to Healthcare Provider").

*NOTE: Please allow 24 to 48 hours for during school; 3-5 days during school closure (ie. holidays, summer break). 

If you have any questions, please feel free to contact Mrs. Olsen at 652-300 x 7876 or