Complete 1 entry for each interested location. A program representative will be in touch soon.

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* 1. All items on this form marked with * are required. By clicking "Yes" below, I acknowledge that this information is provided voluntarily for program registration purposes only. The county cannot guarantee all requests for youth workers can be fulfilled.

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* 2. Employer / Organization Name

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* 3. Sub-site Name

Use this field if your organization has multiple locations.  For example a business called Sprinkles Ice Cream might have locations in Springfield, Barberton, Copley, and Stow. Interested parties should complete one registration form for each location.

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* 4. Primary Contact Person

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* 5. Contact Phone # (no spaces or dashes)

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* 6. Additional Contact Phone # (no spaces or dashes)

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* 7. Email address at which primary contact person can be reached

Essential program communications are transmitted via email. Please ensure an address that can be easily accessed by someone at the worksite is provided.

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* 8. City / Town of Worksite

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* 9. ZIP code (5 digit) in which the worksite is located

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* 10. Did you provide work opportunities in the Summer Youth Employment Program last year?

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* 11. Indicate here which age group(s) of youth your organization would be willing to put to work this summer. You may check more than one box, but must select at least one.

Please be advised that in 2019 the program will serve only youth aged 14-17 as of June 1, 2019.  The program will honor requests requests based upon age restrictions, but there is a special need for work sites willing to provide work to youth aged 14-15. Criminal background checks will not be conducted on minors.

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* 12. Select the maximum number of youth this worksite desires to have assigned.

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i We adjusted the number you entered based on the slider’s scale.
Please note in most circumstances the worksite is responsible for basic supervision of youth workers.  Several factors impact the worksite to which youth are assigned, so the number of workers requested cannot be guaranteed to be met.

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* 13. Is this potential work site part of Summit County's faith-based community and/ or a community service organization that would like to explore providing work opportunities to its own youths?

If you selected 'Yes', a program representative will be in touch soon to explore this possibility. Note: youths to whom you would like to provide work opportunities are required to go through the same registration & eligibility determination process as all others in this program.

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* 14. Does your organization require pre-employment drug testing of its regular employees?

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