TALENT UP FAIRFAX EMPLOYER INTEREST FORM We are a for-profit business, public agency, or nonprofit organization with a physical presence in Fairfax County and are interested in learning more about the Talent Up Fairfax Initiative, a Work-Based Learning (WBL) Demonstration Project. I understand that my business must meet the following expectations for Talent Up Fairfax program participation. Please check if you agree with the Employers Readiness Checklist and Agreement items listed below: My business has a physical presence in Fairfax County. My business is willing to demonstrate its readiness to hire a temporary WBL intern in a hard-to-fill gateway job such as IT, professional sales, and customer service, administrative, accounting and bookkeeping and healthcare. My business is willing to create or modify job opportunities for interns to be more inclusive of non-traditional candidates. My business is willing to provide a career pathway for the intern towards an entry to mid-level permanent position. My business is willing and able to provide positions in occupations with a minimum average wage of $20 per hour. My business is willing to provide a list of job openings with job descriptions and requirements to promote its hard-to-fill positions. Please complete the following information and you will be contacted by the Talent Up Fairfax Business Engagement Manager to discuss next steps for participation in the program.Name of Business Business Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Type Nonprofit Public/Private For-profit Other Business Website Contact Name First Last Position/Title Email PhoneIf you have any questions, please email email@example.com.EmailThis field is for validation purposes and should be left unchanged.