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2023
BUSINESS REGISTRATION
If you have any questions concerning this registration form or general questions about the Summer Youth Works Program,
please contact Paige Evans at
478-272-5546 or email membershipservices@dublin-georgia.com.
Business Name
*
Business category
*
Automotive
Industrial
Government
Finance
Agriculture
Health Care
Education
Technology
Hospitality/Food Services
Other
Contact Person
*
Mailing Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip
*
Physical Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip
*
Phone
*
Email Address
*
Number of Youth Employees you'd like to employ?
*
1
2
3
4
5
6
7
8
9
10
Do you require your youth employee to be 18 years old?
*
Yes
No
Is your company willing to accept a young person with a first-time non-violent felony?
*
Yes
No
Description of the position(s) you will provide.
*
Other important information that you would like to share with the Summer Youth Works Program?
*
Please check that your business accepts the following items*
*
I will host a youth employee(s) at my business from June 12th, 2023 until July 28th, 2023.
I understand that I will need to have a representative from my company present at the McGrath Keen, Sr. Conference Center at the Chamber of Commerce on May 10, 2023 starting at 3:00pm until 5:00pm for Interviews.
I understand all youth employees will be at least 16 years of age and enrolled in high school or a home school program.
I agree to pay youth employees a minimum of $8 per hour for a minimum of 32 hours of work a week for eight weeks through the company's payroll.
I understand that June 5th - 9th will be soft skills training and that I am responsible for paying the student for that first week (which is included in eight weeks listed above)
I understand that my company may require all youth employees to pass a pre-employment drug screening at my company's expense.
I understand that a youth employee(s) will be assigned to my business by the Summer Youth Works panel and I will not have final say in placement.
I understand that my company is required to attend the Summer Youth Works Wrap-Up ceremony on July 28th.