Host Worksite Request Form


Please complete this form: This form shall be used by State Departments to request for IT intern(s) to be placed with their department/division/agency. To help the Department of Labor and Industrial Relations, Workforce Development Division refer an intern that would match your agency’s skill requirements, please complete and submit this Google Form by February 18th, 2022. Please note that the referral will be made on a first come, first serve basis. Telework will not be allowed.


Enter Worksite Address (Street, Apt./Suite/Room, City, Zipcode
Enter Worksite Start and End time (example: 7:45am to 4:30pm)