Qualifying Profile

For Placement Program Employers

EMPLOYER CONTACT INFORMATION

Company Name:

Address:
Street City State Zip Code

Supervisor / Manager: Tax ID #:

Telephone: Fax:

Email: Website:

Workers Compensation Policy Holder: Policy Number:

Do you have an online application? Yes No Application Website:

How did you hear about CCUSA? IAAPA NSAA Colorado Ski Country Website/Search Engine

Friend/Student Other

EMPLOYMENT DETAILS

Dates of Employment: First day of work: Last day of work:

Are these start and end dates flexible? Yes No Desired Number of International Staff:
Jobs Offered (list positions & wages):

Frequency of Pay: Average Hours/Week:

HOUSING

Is employee housing available? Yes No Approximate Cost of Housing:

Deposit Amount: Type of Housing:

ADDITIONAL EMPLOYER COMMENTS

If submitting this form electronically (emailing form) check the box below as an alternative to signing.

Employer Name Signature Date

Once completed, email this form to webd@ccusa.com. If you have any questions please call our Headquarters at 888 44 WEUSA.

901 E. Street, Suite 300, San Rafael, CA 94901 • T [415] 339 2740 • T 888 449 3872 • F [415] 339 2722 • WWW.CCUSA.COM
Rev.26.06.16