Youth Internship Employer Agreement Form

Youth Internship Employer Agreement Form
For employers participating in the youth internship program. Please complete all sections to confirm your organization’s participation and agreement.
Employer/Company Name
Primary Contact Full Name
First NameLast Name
Job Title/Role of Primary Contact
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Internship Role/Title
Internship Start Date
MonthDayYear
Date
Internship End Date
MonthDayYear
Date
By submitting this form, I confirm that I am authorized to sign on behalf of the above-named organization. I acknowledge that the internship will provide supervised, educational work experience for youth, and agree to comply with all program internship requirements.
Should be Empty: