Employer Interest Form
Primary Contact Name
Primary Contact Email Address
Primary Contact Phone Number
Where would this job be located? Please be specific as possible:
Is the workplace accessible by public transit?
No, it is only accessible by car.
Full-Time Paid Internship
Part-Time Paid Internship
Application Deadline Date:
Position Start Date
Position End Date
Number of Positions Available:
3 or more
How Many Hours Per Week
1 - 10 Hours
11 - 20 Hours
21 - 30 Hours
31 - 40 Hours
Primary Job Duties
Additional Details: Please check all that apply.
Requires Standing or Walking
Requires Sitting at a Desk
Requires Moving Heavy Items or Manual Labor
Requires Professional Attire
Requires Work Clothes or a Uniform
Have You Hired YouthCare Youth Before? If yes, please explain:
What Do You Require From Applicants or New Hires?
GED or High School Diploma
Thank You For Your Participation!
If you have any further questions, please email us at
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