Inspire Madison Region Employer Registration Form
Thank you for registering your company with Inspire Madison Region. By completing and submitting this form you will create a profile for your company as well an account for yourself. Through that account, you can access your company/organization profile and also offer online career coaching for your career area(s), offer Experiential Learning Activities and send company messages to students and educators about your organization's career or education-related topics and programs.
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IMPORTANT (BACKGROUND CHECK AUTHORIZATION):
If you plan to serve as an Online Career Coach, offer any Experiential Learning Activities, or send company messages, you give your permission for a background check to be conducted. By completing the form below, you authorize (a) backgroundchecks.com (“BGC”) to request information about you from any public or private information source; (b) anyone to provide information about you to BGC; (c) BGC to provide Madison Region Economic Partnership one or more reports based on that information. BGC will investigate your criminal record and driving record. You acknowledge that a fax, image, or copy of this authorization is as valid as the original. You make this authorization to be valid for as long as you are an applicant or employee with us. By completing this document you also acknowledge the receipt of the attached disclosure form: http://inspiremadisonregion.org/wp-content/uploads/2017/08/MadREP-BGcheck-Disclosure.pdf

We will obtain these reports through a consumer reporting agency. Our consumer reporting agency is backgroundchecks.com (“BGC”). BGC’s address is P.O. Box 353, Chapin, SC 29036. BGC’s telephone number is (866) 265-6602. BGC’s website is www.backgroundchecks.com, where you can find information about whether BGC’s international privacy practices.

The Consumer Financial Protection Bureau’s “Summary of Your Rights under the Fair Credit Reporting Act” is attached here to this authorization. If you are a New York applicant, a copy of New York’s law on the use of criminal records is attached. By completing the form below, you acknowledge receipt of these documents: http://inspiremadisonregion.org/wp-content/uploads/2017/08/FCRA-Reporting-Summary-of-Rights.pdf.
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Once your background check is complete, we will build your profile in the system using the information you provide in this form. If for some reason we are not able to activate you as a career coach based on results of the background checks, we will notify you and include the reason why. If you don't require a background check, then we'll build your profile without one but you won't have access to some of Inspire's most powerful tools. Others in your organization can sign up for any of the activities that require a background check under your company name, however. When your profile is ready (allow up to 14 business days) you will receive an email notification with log in instructions so that you can view the profile. Remember, you can make changes to your profile anytime you'd like! In addition, once your company is active in the system, other employees can register as "Online Career Coaches" by clicking on http://inspiremadisonregion.org/employers/ and then clicking on "Register Now as a Career Coach!".

Don't hesitate to contact us at any time, with any questions or concerns. Our staff is here to help you make this a rewarding experience for both you and our partner schools/students!

Adrian Crabb
acrabb@madisonregion.org
608-345-8378

All of our partner businesses start by creating a Company Profile. In addition to this, which of the following features do you plan to use in your Inspire Madison Region account?
Check all that apply. To learn about Work-based Learning Activities, go to: http://inspiremadisonregion.org/work-based-learning-activities/
Required
Why do you want to get involved with schools/students?
Indicating your objective(s) will help us guide you in creating an Inspire Madison Region profile that will best suit your needs!
Required
Primary Contact First Name
Your answer
Primary Contact Middle Name
Please provide your FULL middle name - not just the initial. This is needed for the background check if you personally plan to serve as a career coach. If you do not have a middle name, type "no middle name".
Your answer
Primary Contact Last Name
Your answer
Primary Contact Date of Birth
This is needed for the background check if you plan on interacting with students at all through your profile (online career coaching, experiential learning, company messages to students)
MM
/
DD
/
YYYY
Primary Contact Gender
Name of Company
Your answer
Primary Contact Title or Position
Your answer
Primary Contact Email Address
Your answer
Re-enter Primary Contact Email Address
Your answer
Primary Contact Phone Number
Your answer
Company Street Address
Your answer
Company City
Your answer
Company State
Your answer
Company Zip Code
Your answer
Company Website Address
If you do not have a website, type "no website"
Your answer
Company Description (700 Characters Max)
Using student-friendly language, describe what your company does and what makes you unique or interesting.
Your answer
Year Founded
Your answer
Number of Employees (approximate is fine)
Your answer
Client Base
Primary Industry
If your company does not fit into any of the below listed industries, choose the closest match
Secondary Industry
If applicable
List the jobs your company hires for
Be as inclusive as possible - if you do not have enough room to list all the jobs, list primary jobs in this registration form. You can add additional jobs once your account has been set up.
Your answer
URL of your Company's Career/Job Opening Page
Your answer
What do you look for in prospective candidates? What qualities, skills,certifications or degrees do you look for? What advice would you have for future employees? What are the in-demand jobs your company offers?
Your answer
Select all of the Experiential Learning Activities your company would be interested in offering/engaging in
You can select as many as you would like. You will also be able to go back and make changes as needed once your profile has been built. For definitions of Experiential Learning Activities please visit: http://inspiremadisonregion.org/wp-content/uploads/2015/06/ContinuumOnePager11x14.pdf
Required
How did you hear about us?
If you heard Inspire through a Chamber of Commerce, please indicate which one.
Your answer
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