Employer Information
Company Name:
Primary Contact Name:
Primary Contact Job Title:
Address:
City: State:   Zip:
Primary Contact Phone:     Fax:
Primary Contact E-mail:
Company web address:
Secondary Contact Name:
Secondary Contact Job Title:
Secondary Contact E-mail:
Number of employees at your company: Small (1-50)     Medium(51 - 100)    Large (100+)
Industry/type of business:

Intern Information
Title/Type of position:
Number of Interns/
Available positions:		   

Ideal working hours:
(i.e. 9:00am -1:00pm) 

Days of the week:
Monday   Tuesday   Wednesday  
Thursday   Friday   Saturday   Sunday
Dress Code:
Business Casual   Business Professional  
Casual  Company Uniform
 
Summer Only Year Round:

Start Date
  End Date    
Salary/hr.    
Referred by: 
Chamber of Commerce (Working Solutions)  
Philadelphia Academies   United Way  
PYN Staff   YPN   Other:


Please describe the Intern’s Duties (or upload a job description below):


Please indicate skills needed and general requirements:


Please indicate if you have already identified interns or would like them to come from a specific School/program (e.g. Philadelphia Academies, Inc.; vocational/technical schools, etc.):


Will there be any additional documentation/clearances needed (to be coordinated and paid for by the employer)? Check all that apply:
Criminal Background:
Child Abuse Clearance:
  Drug Test: 
Physical: 
 Other:

   
 
Job Description
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