Computer and Network Technology Degree and Certificate Programs

Job/Internship Information Form

(To be completed by employer)

Company Name: Address:

Contact Person: City:

State: Zip Code:

Contact Person Email: Phone:

Company Website: Fax:

Location of position: Supervises:

Reports to: Job Title:

Major Job Duties: Start Date:

Is this an Intern Position? Yes No Permanent Full Position? Yes No

Full Time? Part Time? Hours per week:

Days of Week (check): M Tu W Th F S

Minimum Qualifications:

Preferred Qualifications:

Travel Required? Yes No