Youth Employment Program
JUNE 23–AUGUST 8, 2008
WORK EXPERIENCE REQUEST
C O N T A C T I N F O R M A T I O N
Business / Agency Name:
Type of Business / Agency:
Private
Public
Non-Profit
Mailing Address:
City, Zip:
Contact Person:
Phone:
Email:
W O R K E X P E R I E N C E P O S I T I O N
Job Title:
Number of positions to be filled:
Minimum:
Maximum:
Responsibilities to be Performed:
Skills or Knowledge to be Gained (Including Knowledge of Workplace Behavior):
Minimum Skills Needed for Position:
Other Requirements:
W O R K E X P E R I E N C E S I T E
Worksite Address (if different from above):
City, Zip:
Is Work-Experience Site Accessible to Public Transportation?
Yes
No
Has your Business / Agency Participated Before?
When:
Yes
No
NOVA is an equal opportunity employer/program
Auxiliary aids and services available to individuals with disabilities upon request
