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STEP-UP! OMAHA Job Request Form
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STEP-UP! OMAHA Job Request Form
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Agency Name:
*
Contact Person:
*
Phone:
*
Email
*
Address:
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Will youth report to a different address than above?
*
No
No
Yes
Report to Address:
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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?
*
Yes
Yes
No
Preferred Start Date / Time:
*
Name of Position
# of Positions
Work Hours (to-from)
Checkboxes
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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?
Yes
Yes
No
Does this position require a background check?
Yes
Yes
No
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