Employer Registration Only

* Name of Organization/Employer:
* Type of Organization:	Please select... For Profit Governmental Non-Profit
* Organization Industry Sector (NAICS):	Please select... Accommodation and Food Services Administrative and Support and Waste Management and Remediation Services Agriculture, Forestry, Fishing and Hunting Arts, Entertainment, and Recreation Construction Educational Services Finance and Insurance Health Care and Social Assistance Information Management of Companies and Enterprises Manufacturing Mining, Quarrying, and Oil and Gas Extraction Other Services (except Public Administration) Professional, Scientific, and Technical Services Public Administration Real Estate and Rental and Leasing Retail Trade Transportation and Warehousing Utilities Wholesale Trade
* Worksite Address:
* City:
* State:	ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING	* Zip Code:
* Telephone:		Fax Number:

---

	* Name	* Title:	* Phone Number	* Email
* Primary Contact:
* Alternate Contact:

---

* Do you have a Federal ID number?	YesNo
FEIN:	-
* Has your organization participated in past CSSF Youth Work Programs?	YesNo
* How many youth will your company hire? Priority will be given for requests of 5 or more youths.

---

---

For information call: 305-594-7615

CareerSource South Florida is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. All voice telephone numbers on this document may be reached by persons using TTY/TDD equipment via the Florida Relay Service at 711.