Co-op/Job Information Form

Co-op/Job Information Form

Organization/Firm *
Contact Person * First Last
Title *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Telephone Number * - (###) - ### ####
Fax Number - (###) - ### ####
E-mail *
Disclaimer

We are not able to accept internship opportunities with home-based businesses/organizations. If you require any further clarification of this policy, please contact our office directly.
Job Information

Please complete the following job information.
Job Title *
Duties/Responsibilities during the Co-op *
Specific Majors Sought *
Additional Comments
Is this for a specific student?
Requirements
U.S. Citizenship * Yes No
Automobile * Yes No
Starting Date * / MM / DD YYYY
Concluding Date * / MM / DD YYYY
Application Deadline * / MM / DD YYYY
Position available which semester(s)
Number of Openings Available *
Student Level(s) *
Salary Amount * $ . Dollars Cents
Pay Period *
Hours * Part-time (minimum 15 hrs per week) Full-time (minimum 35 hrs per week)
Non-Discrimination Statement
This employer does not discriminate based on age, sex, race, religion, national origin, marital status or handicap. * Agree Disagree