Work Immersion Application

Work Immersion Application

Please submit one (1) application for each participant you wish to enroll.
Before completing a Work Immersion Application, please review the Work Immersion Program Guide and then proceed below.
To complete this application you will need the following information:

Internship/Work Experience Details
Participant's Work Immersion Start Date (Anticipated Date of Hire):*

MonthDayYear
NOTE: Employment may start at any time after this application is submitted, however, the submission of this application does not guarantee approval and the GWB cannot reimburse for wages earned prior to the start of a fully executed contract.
Anticipated Work Immersion End Date:*

MonthDayYear
Total Anticipated Work Immersion Hours:*
NOTE: The Work Immersion experience must be a minimum of 80 hours. The maximum number of reimbursable hours is 400.
Participant's Occupation During Work Immersion:*
Work Immersion Wage (Participant's Hourly Rate of Pay):*
ex: 15.00
NOTE: Participants must be paid an hourly wage of at least $15.00 per hour in the Work Immersion program. If the hourly rate of pay is greater than $20.00 per hour, the GWB will calculate reimbursements as if the hourly rate of pay is $20.
Is this Work Immersion experience relevant to the participant's interests or area of study?*

YesNoI don't know
Describe how this Work Immersion experience will benefit the participant:*

Employer Attestations & Signature
I have reviewed the Work Immersion Program Guide and understand my obligations as an employer.*
Please Initial
My organization is registered as an approved RI state supplier in the Ocean State Procures 'OSP' system.*
Please Initial
The individual I seek to enroll in Work Immersion is authorized to work in the United States.*
Please Initial
The individual I seek to enroll in Work Immersion will be hired as a W-2 employee of my organization and NOT as a 1099 independent contractor.*
Please Initial
The individual I seek to enroll in Work Immersion has no prior employment relationship with my organization and is not an existing or former employee.*
Please Initial
By signing below, I attest that the information contained in this application is correct and accurate to the best of my knowledge.
Signature*

Clear
Should be Empty:

Employer Information