Summer Youth Employers

Fields marked with * are required.

Employer Information Request:
* Full Name (Last, First, MI):
* Title:
* Company:
* Street Address:
* City:
* State:
* Zip Code:
* Phone Number:
Fax Number:
* E-mail:
* Total Number of Employees Needed:
* Type of Work to be Performed:

Please specify the number of youth for each job description. If there are time, age or attire restrictions for each positions, please include it. If we are unable to meet your restrictions, we will consult you prior to placing different students at your site.

Summary Job Descriptions:
Number of Clerical Employees Needed:
Job Description:
Number of Custodial Employees Needed:
Job Description:
Number of Childcare Employees Needed:
Job Description:
Number of Other Employees Needed:
Job Description:

Additional Information:
* Is the bus stop within reasonable walking distance?	yes no
* Do you require background checks or drug screens for your current employees?	yes no
* Would you be willing to hire non-violent offenders?	yes no
* Are you a licensed childcare facility?	yes no

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