BUSINESS REGISTRATION

If you have any questions concerning this registration form or general questions about the Summer Youth Works Program, please contact Kesla Holder at

478-277-1404 or email holderk@dublinga.org.

Business Name *

Business category *

Contact Person *

Mailing Address *

City *

State *

Zip *

Physical Address

City *

State *

Zip *

Phone

Email Address *

Number of Youth Employees *

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 Works Program? *

Please check that your business accepts the following items* *

I will host a youth employee(s) at my business from June 10, 2019 until July 26, 2019.

I understand all youth employees will be at least 16 and enrolled in high school or a home school program.

I agree to pay youth employees $8 an hour for a minimum of 32 hours of work a week.

I understand that the program "Kick Off" will be on May 30, 2019 and I am required to attend or send a representative.

I understand that June 3rd-7th will be soft skills training and that I am responsible for paying the student for that first week.

I understand that all youth employees will pass a pre-employment drug screening.

I understand that a youth employee(s) will be assigned to my business.

Please check the payment method your business prefers.* The estimated cost of a youth employee this summer will be $2,700, which includes a pre-employment drug screen and background check. There will be additional cost if you choose to use the staffing agency. *

I prefer to place the youth employee(s) on my own payroll.

I prefer to place the youth employee(s) on the payroll of a staffing company and be billed.

I prefer to sponsor a youth employee(s) for a local non-profit.

My business is a local non-profit and I will receive a sponsored youth employee.