STEP-UP! OMAHA Job Request Form

Agency Name: *

Contact Person: *

Phone: *

Email *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Will youth report to a different address than above? *

The 2023 summer program runs from Monday, June 5, 2023 – Friday, August 4, 2023. Step-Up participants have 2 weeks of program orientation and career preparation training and will be available for worksite placement on Monday, June 19th. If you are in need of your intern prior to this date, please indicate that below.

Do you need your intern(s) earlier than June 20th? *

Name of Position

# of Positions

Work Hours (to-from)

Supervisor Name: *

First

Last

If you have a preference for a youth to fill a position, please indicate the name of the youth and position to be filled:

Job Description

Position Title 1:

Job Description:

Specific Qualifications:

Skills to be obtained:

Does this position require drug testing?

Does this position require a background check?

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