CEO Internship Employer Form -

CEO Internship Employer Form

High School Junior and Senior students have an opportunity to earn high school credit for participating in the Ottawa County Business Advisory Council's CEO Internship Program. The CEO Internship program provides students with a pathway between school and work. Students develop entry level skills in a specific occupation, practice career management, and prepare for employment all while earning high school credit. The CEO Internship has several benefits:

-students can earn 1/2 credit and a stipend of $250 for every 60 hours of internship time completed
-the internship is flexible. This presents a wide-range of possibilities for hours/schedules (i.e. – can be done afterschool, during school, weekends, etc)
-the internship gives the students an opportunity to “test the waters” of a desired occupation

Businesses must complete this form in order for the student to participate in the CEO Internship Program.

Business Information

Name of Business/Organization *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Internship Site Supervisor Name *

First

Last

Title *

Cell Phone *

Email *

Business Questions

The Internship Site Supervisor is responsible for the following:

Day-to-day management of interns
Work oversight, direction and feedback
Training, motivating and developing the student intern
Evaluating intern performance

Will the student intern need certain training or knowledge prior to the start of the internship? If so, please explain. *

Will the student intern need to be 18 years old? *

All students will have parent/legal guardian consent to participate in the internship program.

Will the student intern require a background check (BCI check)? *

Will the student need a Drug Screen? *

How many student intern positions will your organization have available at this time? *

Please describe each internship position available. *

Comments/Questions

Additional Information:

- Internship/work experience will vary in length and students will earn high school credit.
- Student internship work times can be flexible, however work times should be discussed and agreed upon between the student, the business and the school.
- The CEO Administrator will communicate regularly during the internship to monitor the progress of the experience.
- Program and performance evaluations will be completed at the end of the internship.
- The student will present to the BAC as a part of the internship.

Internship Site Agreement

As the Internship Site Supervisor, I agree to the following:

- Provide student with structured on-site exposure to work, the development of good work habits, and basic work skills.
- Discuss with the student the expectations each of you has for the internship experience.
- Present training in a practical sequence and include instruction and experience in work processes relevant to the occupation as performed by the Training Provider.
- Make certain that the student is not receiving conflicting instructions from different supervisors.
- Provide and furnish, at your own expense, all instructions, materials, equipment, supplies, and services necessary for the training and experience of the student.
- Provide training that covers safety and work-site regulations.
- Provide student with relevant safety instructions and equipment necessary for reasonable protection against injury and harm. Accidents involving a student shall be reported to the school immediately.
- Advise the student of all customary practices of the Training Provider and normal requirements of the job, including personnel practices and policies.
- Ensure that students are accepted and assigned jobs in accordance with the Child Labor Laws and treated equally regardless of race, color, national origin, gender or disability.
- Prohibit the assignment of students to positions involving political activities.

This agreement shall be in effect from: *

to: *

Termination of Agreement

The Internship Site Provider or School may cancel this agreement at any time through the mutual agreement by both parties. Students will be aware that termination is a possibility at the internship site.

Intern Information

The Internship Site (employer) agrees to accept the following student as an Intern:

Name of Intern *

First

Last

Name of High School *

Age *

Cell Phone *

The Intern’s proposed daily schedule will be:

Please be as specific as possible (i.e. Mondays from 9am to 11:30am, etc.). The intern's timesheet shall be utilized; Supervisor will monitor & sign the timesheet and email to the CEO Administrator.

Total number of hours per week: *

This can be an average/estimated number (i.e. 10 to 16 hours per week)

Confirmation

I confirm I have completed the Business Information, the Business Questions and the Internship Site Agreement sections. I confirm that I have digitally signed the CEO Employer Form.

Internship Site Supervisor Signature *

Date *

Employer Signature *

Signature of CEO/President/Owner, etc. of the business

Date *

Email Confirmation

Once you submit the completed form, you will receive an email confirmation along with a copy of the CEO Employer Form (be sure to check your junk/spam folder).

Please call (419) 898-6242 or email crodenhauser@ocic.biz with questions.

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