DLIR Volunteer Internship Program (V.I.P.) Business Request Form

Can information on this V.I.P. request form be made available to the public on-line?
Yes No
Company Name: Company Website:
*

Contact Information:
  Contact Person: Phone No: Fax No:
  * *
  E-mail Address:
  *
  How do you prefer applicants contact you?
  Telephone Mail Resume Fax Resume E-Mail In Person at Interview Address
Other
Company Address:
  Street:
  *
 
  City: State: Zip:
  * * *
  County:
 
Interview Address: (If same as company address, leave blank)
  Street:
 
 
  City: State: Zip:
 
  Is public transportation available? Yes No
Internship Location: (If same as above addresses, leave blank and select address) Company Address Internship Location
  Street:
 
 
  City: State: Zip:
 
  Is public transportation available? Yes No

List Specific Interview Times, if any:
Special Directions to Interview Location, if any:

Internship (Training) Information:
  Title of Internship (Training) Position:   Number of Openings
  * *
  Number of Hours Per Week: Internship (Training) schedule:
  (Cannot exceed 32 hours/week)    (ie. 9:00-5:00 Mon-Wed)
  Minimum age required? Yes No If YES, what age and why?
  Driver's License required? Yes No If YES, why?
  Occupational license required? Yes No If YES, what license?
  If keyboarding is required, enter minimum words per minute:
 
  Experience Required of Intern, if applicable:
 
  Education Required of Intern:
 
  What are the required skills & qualifications, if any, needed for this internship (training) position?
  *
  Do you have any preferred skills or qualifications for this internship (training) position?
 
  Training will be provided on (Describe the training):
  *
  Check this box If an intern has already been found, and please enter the information below:
  Intern First Name: M.I. Last Name:
  Intern email Address:
Intern Phone Number: