Summer Youth Employment Program Worksite Application

Summer Youth Employment Program Worksite Application Form

Each year, the Town of Hempstead Department of Occupational Resources (DOOR) implements a work experience program for eligible youth who are Town of Hempstead/City of Long Beach residents, ages 16-20, and low-income. For six weeks during the summer, youth are placed in various worksites within the area and serve as interns. This year, youth will be paid (by HempsteadWorks) $17 an hour and work up to 30 hours a week. The program will run from July 8 through August 16, 2024.

HempsteadWorks also compensates employers for supervising these youth.

As a worksite during the summer youth employment program, each worksite will be responsible for the following:

Assigning staff to supervise youth interns
Providing youth with a brief orientation on their worksite duties, attendance policies, etc.
Gathering youth’s timesheets and submitting them to DOOR on a biweekly basis
Monitoring youth attendance, punctuality and job performance

To become a worksite for the summer youth employment program, please complete the worksite application below and upload a W-9, as well as a detailed job description(s), on your company letterhead, of the work in which youth interns will be engaged. The deadline to complete this application form is Friday, May 24, 2024.

Please note that submission of an application does not guarantee that youth with be placed at your establishment.

Date:

1. Please indicate the number of youth you can place for the summer program.

2. To what sector does your business belong?

2a. If the applicant is a School District, can you take on youth participants that are not currently enrolled in any of the applicant’s schools?

Yes

No

N/A

3. Is your business Minority/Women-owned Business Enterprise (MWBE)?

Yes

No

4. To which industry does your organization belong (select all that apply)?

5. Has the establishment been the subject of a Federal, State, or City investigation, criminal, or civil action?

Yes

No

6. Is the worksite child-care related?

Yes

No

7. Will youth participants be instructed to work outside?

Yes

No

8. Will youth participants work on community service projects?

Yes

No

9. Will youth participants be instructed to handle dangerous tools (e.g. power tools or knives)?

Yes

No

10. Will you require youth to submit to a background check?

Yes

No

11. Can your business hire individuals who are 16 and 17 years of age?

Yes

No

12. Do you require that interns interview with you before being placed at your business?

Yes

No

Please upload a detailed job description (s) (.doc or .docx only), on your company letterhead, of the work in which youth will be engaged. The job description must include youth’s proposed work schedules, including days of the week and number of hours. They are entitled to a 30 minute lunch break and may not work more than 6 hours each workday.

If you have more than one job description, please add them onto one document.

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