| Professional
Information |
First
Name |
* |
|
Middle Initial |
|
|
Last
Name |
* |
|
|
|
(ex: President; CEO;
HR Manager) |
| |
| Username &
Password |
Email Address &
Username
|
* |
|
Password |
* |
|
Re-enter
Password to Confirm |
* |
|
| Contact Information
|
Address
1 |
* |
|
Address 2 |
|
|
Address 3 |
|
|
| City |
* |
|
State |
* |
|
Zip |
* |
-
|
Telephone |
* |
(
)-
-
|
Telephone Ext. |
|
x
|
| Company Information
|
Company
Name |
* |
|
| |
|
Check this box if you are a non-profit organization
|
|
|
(at the
location listed under Contact Information) |
Company Size |
|
(overall)
|
Annual Gross Revenue |
|
|
Years in business |
|
|
Industry |
|
|
Accessible by public
transportation? |
|
Yes
No |
Have you used interns
before? |
|
Yes
No |
Number of years using
interns |
|
|
Number of interns
used in the past |
|
|
Company
Description |
|
Note: There is a 3000
character limit for your description
with HTML tags '<b><i><u><br><ul><ol><li>' allowed
Count Characters |
| Non Profit Company
Information |
| Tax Code |
** |
|
| |
|
**This field is necessary
if you indicated you are non-profit organization. |
| Miscellaneous |
Tips |
|
|
| |
|
|
