Employer Request Form01

For Office Use Only  Job Number:   ________________  Date Logged:  ________________ 

EMPLOYMENT SERVICES

 Logged by:  ________

Hartnell College, Career Center   Cooperative Work Experience Education

E­mail: [email protected]

EMPLOYER REQUEST FORM Business/Agency/Organization

Phone

Department Contact Person 3 Employer Site Supervisor **

Phone Phone

.

Address

. No.

Street

City

Zip Code

Fax :

E-mail :

Indicate Type of Position(s):  Permanent Employment Number of Positions Available:  One semester  Two semester  Summer session



Subsidized Training



Temporary

Compensation: $_________________  Hourly  Monthly  Yearly  Full-time  Part-time DAYS: __________________

Other (specify): __________________________________ _______________________________________________

HOURS: __________________

Type of Industry/Organization/Business: _______________________________________________ Job Title: _________________________________________________________________________________ Description (e.g., duties, responsibilities, activities to be performed):

Requirements (e.g., basic qualifications and/or special skills, experience or academic background preferred):

Training/Orientation provided (e.g., self-paced, classroom, and/or on the job training, and/or mentoring):

Applicant Selection Process:  Schedule appointment with

PHONE:

    Other Please return request form to:

. EMPLOYMENT/INTERNSHIP PROGRAM Hartnell College, Career Center Cooperative Work Experience Education 156 Homestead Avenue, Salinas, CA 93901 Phone: (831) 755-6925 Fax: (831) 770-6115

.