For Office Use Only

 Job Number:   ________________

 Date Logged:  ________________ 
EMPLOYMENT SERVICES
 Logged by:  ________
Hartnell College, Career Center  
Cooperative Work Experience Education
E­mail: careers@hartnell.cc.ca.us
EMPLOYER REQUEST FORM
Business/Agency/Organization Phone
Department Contact Person Phone
3
Employer Site Supervisor ** Phone .
Address .
No. Street City Zip Code
Fax : E-mail :

Indicate Type of Position(s):  Permanent Employment  Subsidized Training  Temporary

Number of Positions Available: Compensation: $_________________

 One semester  Hourly  Monthly  Yearly
 Two semester  Full-time  Part-time
 Summer session 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