Urban Champions 2022-23 Employer Application

URBAN LEAGUE
Urban Champions Youth Employer Application
EIN/TIN
Employer/Company Name
Worksite Address

Street Address

Street Address Line 2

City, State & Zip CodeState / Province

Postal / Zip Code
Phone Number
Email Address
example@example.com
Website Address
Primary Contact
Title
Worksite Supervisor
Supervisor Phone Number
Business Type
Does your company have General Liability Insurance?

Yes (If so, please attach a copy)No
Which sector best describes your business?
ATTENDING AN EMPLOYER ORIENTATION IS MANDATORY please name your representative
URBAN LEAGUE
Position Type/Title
# of Positions
Preferred Age of Youth

1415161718
Days of work

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Daily Start time
Daily End time
Number of work hours offered per week (# of hours per week (not to exceed 20)
Time of Lunch and/or Break
Skills/Qualifications Required
5 Primary Duties, Tasks, Responsibilities
1.
2.
3.
4.
5.
Special attire, uniform, criminal background check, car/ability travel, driver's license
You will receive a follow-up letter with further information after receipt of the application.
URBAN LEAGUE OF GREATER SOUTHWESTERN OHIO
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Urban Champions Youth Employer Application