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) $16 an hour and work 30 hours a week.  Youth can only work The program will run from July 1, 2022 to August 12, 2022.

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 6, 2022.

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

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?
3. Is your business Minority/Women-owned Business Enterprise (MWBE)?
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?
6. Is the worksite child-care related?
7. Will youth participants be instructed to work outside?
8. Will youth participants work on community service projects?
9. Will youth participants be instructed to handle dangerous tools (e.g. power tools or knives)?
10. Will you require youth to submit to a background check?
11. Can your business hire individuals who are 16 and 17 years of age?
12. Do you require that interns interview with you before being placed at your business?

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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