Company Registration Click here to download our Employer Packet Company Name:*Company Contact Name:* First Last Title:*Department:*Email:* Enter Email Confirm Email Phone:*Preferred Contact Method:* Email Phone Company Address:* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Company Website:*Facebook URL:Twitter URL:Instagram URL:LinkedIn URL:Snapchat URL:Industry:*AgricultureAccountingAdvertisingAerospaceAircraftAirlineApparel and AccessoriesArtsAutomotiveBanking / Financial ServicesBroadcastingBrokerageBiotechnologyCargo HandlingCarpentryChemicalComputer / ElectronicsConstructionConsultingConsumer ProductsCosmeticsDefenseEducationElectricianEnergyEntertainmentFood & BeverageHealthcareHospitalityLegalManufacturingMediaMusicPharmaceuticalsPlumbingPublishingRetailSportsTransportationOtherIf you selected other (above), please explain:What job duties do you plan to show your apprentices? Please list: (example: cooking, management, design, small business, etc)*What will be the learning outcomes? Please list: (example: The student will learn how to...)*Tell us about your business (bio):*Upload Your LogoUpload photos of your business and staff (helps our apprentices visualize the job) Drop files here or Are you able to give a tour of the facility?*-- Choose One --YesNoDo you have age requirements? If so, please tell us. (youth apprentices are aged 6-18)How many apprentices will you host:*3-55-10unlimitedotherIf other, please explain:How often will you host your Apprentice Day?*MonthlyQuarterlyBi-YearlyYearlyOtherIf other, please explain:*Select your first Apprentice Day: (If you choose to participate "as the need arises", skip this option) Date Format: MM slash DD slash YYYY Check this box if you choose to participate "as the need arises" When a student comes across your apprentice day job listing, they will sign-up. Our team will contact you to schedule a date. What is your "start" and "end" time? (recommended 3-4 hours)*If you are providing any of the following, please select them:LunchSnacksRefreshmentsHow did you hear about Apprentice Day?*Friend/RelativeSchoolAdvertisementSocial MediaOtherIf other, please explain:*Would you be willing to mentor an Apprentice?*-- Choose One --YesNoMaybeMay we use your apprentice day photos from this event for media purposes?*-- Choose One --YesNoSKILLED JOBS DEPEND ON A SKILLED WORKFORCE. Every child deserves a fair and equal opportunity to succeed in life, starting with skills training and employment opportunities that inspire them to grow. Whether you donate $5 or $500, every little bit helps. Thank you for your support. ApprenticeDay.org/DonateDo you agree to the terms and conditions?* Yes http://apprenticeday.org/terms-conditionsDeclaration: I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it. I hereby authorize National Apprentice Day to include the company, I am representing, into their program.Signature*Electronic Signature (printed)*Date* Date Format: MM slash DD slash YYYY This iframe contains the logic required to handle Ajax powered Gravity Forms.