OCGJC Worksite Form

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Green Jobs Corps Worksite Application

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FOR QUESTIONS OR ADDITIONAL INFORMATION,
PLEASE CALL 714-567-7528, TDD 711,
OR E-MAIL US AT ocsyep@hcs.ocgov.com

Organization Name:*
Phone Number:*
Fax Number:
Email Address:*
Address:
City:
Zip Code:
Location of Worksite(s): (If youth will be assigned to more than one location, please list all addresses)
Name/Title of Worksite Supervisor:
Name/Title of Alternate Worksite Supervisor:
Organization Type:	Non-Profit Public Sector Agency Educational Institution Business
Number of OCGJC Youth Workers Requested:
List of Age Restrictions for Job: (if any)
Requested Work Schedule:
Tools/Equipment OCGJC Workers may be using at work:
Please identify if required for OCGJC youth:	Safety Equipment (please list): Uniform (please explain): Other (please describe):
Is your Facility Handicapped Accessible? Yes No
Worksite and Alternate Supervisors will be required to attend a Worksite Orientation Meeting (approximately 30 minutes).

The OCGJC is made available through funding from the American
Recovery and Reinvestment Act (Economic Stimulus). OCGJC is
administered by the Orange County Workforce Investment Board and Youth Council
on behalf of the County of Orange and is an Equal Opportunity Employer/Program. Auxiliary
aids and services are available upon request to individuals with disabilities.