Dominica Employment & Small Business Support Agency Employment Creation and Mentorship Programme Employer Application Form

Dominica Employment & Small Business Support Agency

Employment Creation and Mentorship Programme

Employer Application Form

Name of Company/Organization: ………………………………………………………………………………………………..

Address: ……………………………………………………………………………………………………………………………………..

Telephone: …………………………………………………………..

Fax: ………………………………………………………………………

Email: …………………………………………………………………..

Website: ………………………………………………………………

Contact Person: ……………………………………………………………………………………………………………………………

Position: ……………………………………………………………………………………………………………………………………….

Sector:

Public Sector

NGO/Statutory Corporation

Private Sector

Tourism

Agriculture/Agro processing

Manufacturing

Services

Number of Employees: ……………

Description of Activities: ………………………………………………………………………………………………………...

………………………………………………………………………………………………………………………………………………..

Indicate the positions available for placement/on-the-job training

Position Qualifications Salary/Wage Location

1.…………………………………………. ………………………………………… ……………………… ………………………

2…………………………………………. ………………………………………… ……………………… ………………………

3…………………………………………. ………………………………………… ……………………… ………………………

4…………………………………………. ………………………………………… ……………………… ………………………

5…………………………………………. ………………………………………… ……………………… ………………………

Additional Information

………………………………………………………………………………………………………………………………………………………………….

Mentorship Programme

Would you be interested in serving as a mentor to youth with interest in entrepreneurship?

Yes

How many youth would you be willing to mentor? ………………..

How many hours per week would you be willing to spend with a mentee? ……………

…………………………………………………….. …………………………………………………..

NAME SIGNATURE