CareerSource Paid Work Experience Employer Application

Company Contact Information

Name of business*

What industry does your business fall under?*

Write in your industry or futher details if it was not included in list above

Street Address*

City*

Select or enter value

Website*

Point of Contact First Name*

Last Name

Contact Person's Title*

Phone Number*

Email*

How many TOTAL students would you be interested in hosting at any given time?*

How many hours per week will students be available to work?*

What are the daily operating hours?*

Please include if you are flexible with what hours students work within your operating hours

What days are students able to work?*

Please include if you are flexible with what days students work

Please provide a brief job description (2-3 sentences)*

Every student will have a background check. Does your organization require a level 1 or a level 2 background check?*

No Background Check Needed

Level 1

Level 2

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