Employer Application Request Form

* Required fields


Company Name *
Type of Business *
Contact First Name *
Contact Last Name *
Contact Title *

Address 1 *
Address 2
City *
State *
Zip code *

Telephone (xxx) xxx-xxxxx *
Fax (xxx) xxx-xxxxx
Email *
Email confirmation *
Website

Program(s) of Interest*: Jobs America, H2B America, Internship America		Jobs America H2B Internship
What is your busy season?*		Spring Summer Winter All year
How many participants are you interested in receiving next season?*
What types of jobs will you have available?*
Do you currently cooperate with another Work/Travel organization?*		Yes No
If yes, please list.
Do you offer housing?*		Yes No
Please describe housing offered or sources for short-term housing in your area. *
How did you hear about us?*