Employer Information Form

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District Financial Aid Office
11011 SW 104 Street, Room 1125, Miami, FL 33176
Florida Work Experience Program: (305) 237-0381
Email: workprogram@mdc.edu

Employer Information Form

Date: 11/21/2024

Company's Name:

Company Website:

Name of Owner, Manager or CEO:

Name and title of contact person or student supervisor (If different from above) :

Type of Business:

Street Address:

City:

State:

Zip Code:

Mailing Address:

City:

State:

Zip Code:

Phone Number:

Fax Number:

E-mail:

Taxpayer Identification Number:

Has your company partifipated in the FWEP Program before?

Yes

If YES when?

What is the minimum hourly wage rate of the position(s) you plan to offer?

Company Profile:

List positions you are posting for hire under FWEP:

Minimum skills required for the job: (e.g. proficient in Microsoft Word, Excel, and Power Point etc.)

How many openings are available? (no more than 5)

What kind of training or career counseling can you offer to the MDC student employees?

Employer's signature: ___________________________________________

FWEP Representative: ___________________________________________

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