FY 2017 CYEP NOFO Application
Appendix E
Employer/Worksite Information
Employer Name: / Is the provider a subcontractor?□ Yes □ No
Worksite Name: / If yes, provide the contract amount:
$
Address: / City: / County: / Zip:
Worksite Supervisor Name: / Title:
Phone: / Fax: / Email:
Designate CYEP Targeted Industries/Career Cluster(s) at this site:
q Agricultural, Food & Natural Resources
q Architecture & Construction
q Arts
q Audio/Video Technology & Communications
q Business Management & Administration
q Education & Training
q Finance
q Government & Public Administration
q Health Science / q Hospitality & Tourism
q Human Services
q Information Technology
q Law, Public Safety, Corrections & Security
q Manufacturing
q Marketing
q Science, Technology, Engineering, & Mathematics
q Transportation, Distribution, & Logistics
Total number of Job Placements available at this site: ______
Below, please provide a breakdown of these job placements. If a job will be subsidized in whole or in part for a period of time, they should be listed under “subsidized”. Only include jobs under “unsubsidized” if that job is totally unsubsidized. If a job is being subsidized in whole or in part with funds other than these DHS grant dollars, please list in the “subsidized” section below and provide the specific detail in the narrative boxes below to indicate the subsidy source and to differentiate between Grant and other subsidized.
Subsidized
Total # of subsidized Job Placements Available: ______
Total # of Part-Time: ______Part Time = ______hours/week
Total # of Full-Time:______Full Time = ______hours/week / Unsubsidized
Total # of unsubsidized Job Placements Available: ______
Total # of Part-Time: ______Part-Time = ______hours/week
Total # of Full-Time:______Full-Time = ______hours/week
For each different position, please indicate the job title; brief description of duties; full-time or part-time; if the initial placement will be subsidized or unsubsidized; total wage rate; if subsidized, describe terms; and the total number of available placements for that job.
Provide a detailed description of the youth wage payment terms for this site including: wage amount, how wages will be paid and by whom, plan to ensure subsidized jobs become unsubsidized, and how work will be tracked and reported to provider.
Describe the commitment made by this employer to providing long-term, sustained, unsubsidized employment for CYEP youth. Include numbers.
Performance Target: 100% of Job Placements will be expected as indicated above under “Total # Placements at Site”. How many of these youth are projected to remain successfully employed from this site following program completion?
Signed Worksite Agreement included with application: Yes____ No ____
Draft or sample Worksite Agreement included with application: Yes____ No ____