f 4, THE JAMES FLOYDMUSCOGEE ( CREEK) NATION

PRINCIPAL CHIEF

1+(":'° " If Employment& Training Administration LOUIS HICKS

P. Q. Box 580 I Okmuigee, OK 74447 SECOND CHIEFT 918.732, 77801 F 918.732.7781

Hesci! Potential Worksite,

Thank you for expressing interest in the Muscogee ( Creek) Nation Summer Youth WorkProgram ( hereinafter" MCN Summer Youth Work Program"). The MCN Summer Youth Work

Program brings together tribal departments and agencies, private sector employers,

community organizations, and local, state and federal governmental agencies to provide

Muscogee (Creek Nation youth between the ages 16- 21 with an array of summer workexperiences to cultivate and stimulate professional and personal career aspirations. The

program is an eight-week program.

Potential employers, located within the jurisdictional boundaries of the Muscogee( Creek)

Nation, make the MCN Summer Youth Work Program possible by volunteering to serve as host

employers and providing structured job opportunities for our youth during the summer. While

your participation is voluntary, the Muscogee ( Creek) Nation will pay stipends/ wages directly

to the youth workers assigned to your worksite; however, the Nation will not provide fundingfor any additional costs that a host employer may incur.

Please find enclosed a MCN Summer Youth Work Program Agreement. This Agreement must

be completed for your program, agency, business, or organization in order to serve as a hostemployer for the MCN Summer Youth Work Program.

If you have any questions regarding the Agreement, please contact the Muscogee ( Creek)

Nation Employment and Training Workforce Development Coordinator, Jessinna McBee at

918) 732- 7780.

Deadline January 31, 2017

Please return application to jmcbee@mcn- nsn. gov

or fax to ( 918) 732- 7781

Pagel of 1

Muscogee (Creek) Nation 4l6ttRElk k

Department of Education& Training au`' g? fi aEmployment& TrainingYouth Works Program t_

MINT F11°.

REQUEST FOR SUMMER YOUTH ( New Worksite)

Serving youth throughout the following counties: McIntosh, Okmulgee, Hughes Okfuskee, Muskogee, Wagoner, Tulsa, Rogers,Mayes and Creek

NAME OF WORKSITE OR BUSINESS: CAREER CLUSTER( See List) NATIVE AMERICAN OWNED:

Hoke 1 R o lie.. Sawa aw, 4-01.4- te.a- 4-t YES NO

NAM OF CONTACT PERSON: EMAIL:

faterr, RA d 4 vnmt fovote loasehot, is: 01"

MAILING ADDRESS: CITY STATE ZIP

10 15. flhi .h frokar, J 14-o4FINDING ADDRESS: CITY STATE ZIP

Scant..PHONE NUMBER: CELL NUMBER: FAX NUMBER

611q- 259- 59' °I 6111- 810- W02i qie a51- iJloriMCN CO X: MCN DIVISION 0 ALTH: DAY CARE FAC ITY:

YES NO YES YES NO

IF YOU REQUIRE ANY SPECIAL SKILLS OR TRAINING FOR THIS PATICULAR WORKSITE PLEASE LIST THEM BELOW:All participants who will work on the MCN Tribal Complex, with the MCN: Division of Health and any day care will participate in mandatory trainings on

the first day of the Summer Youth Employment program.)

PLEASE LIST HOW MANY POSITIONS YOU WILLWILL

Z

HAVE AVAILABLE( maxi mu m 3 pe r site

JOB' TITL orrma l e o 6t0 jOB3bUT ESfh fsay. eper,.) y

tor15 Lor at ,ra.5, l e t/ w1'Ltt e- ic 3. pi

1. 9rovi6i cYJ Otty Julio a c u SCS At4).&1

author of Work/1r

2,

3,

CHECKLIST

Request for Summer Youth

Worksite Legal Agreement

Proof of Business( license, OTC documents, etc.)

1040 Form, Tax ID#, Statement from Bank

Muscogee( Creek) Nation Tribal Complex• P. 0. Box 580• Okmulgee, Oklahoma 74447

1- 800-482- 1979• 918-732-7773• Fax 918- 732- 7696 or 918- 732-7781• etaCThmcn- nsn. gov

Deadline to submit Worksite Application is January 31, 2017

Muscogee( Creek) Nation t KR!` k'NDepartment of Education& Training F- ;` `' o

Employment& Training oYouth Works Program ii.

a ?_a

r'Nt NT ka,

PLEASE INDICATE WHAT AGES OF PARTICIPANTS YOU CAN ACCOMMODATE: ( Circle all that apply.)

16 17 18 19 20 21 ANY

PLEASE INDICATE THE DAYS YOUR BUSINESSES IS OPEN AND LIST THE TIMES OF OPERATION :

SUN: am/ pm to am/ pm Other: la!. 4.!,.. 1 _. 1l u.A . 0 ...:._1.

MON: 8 am/ pm to C am/ pm 0,1 haul •TUE: S am/ pm to 5 am/ pm

WED: g am/ pm to am/ pm

THU: E am/ pm to am/ pm

FRI: 8 am/ pm to am/ pm

SAT: am/ pm to am/ pm

PLEASE PUT AN j Y GH REQUIREMENT YOU WILL Pl ASEP„(tT: /. EX BY EACH ITEM THE YOUTh W L EEDSEED FOR YOUR BUSINESS ” 0

1 OR SOUR BUSINESS

FOR OSBI AND IMMUNIZATIONS, PLEASE LIST SPECIFICTESTS NEEDEMDRUG TEST: SCRUBS:

OSBI: WORKBOOTS:

TB TEST: STEEL TOED BOOTS:

IMMUNIZATIONS: SAFETY GLASSES:

OTHER: WORK GLOVES:

PROFESSIONAL CLOTHES:

OTHER:

Statement of Understanding

Worksites

I verify that I have read the Summer Youth Employment Program Worksite Guidelines and Expectations. Iacknowledge an understanding of this information. If determined eligible to participate in the SYEP I agree to

comply with the Expectations and Guidelines.

I further understand that if fail to comply with this Statement of Understanding it could affect my ability toparticipate as a worksite with the MCN Youth Works program.

Date

Name of Employer or Supervisor

Deadline to submit Worksite Application is January 31, 2017

MUSCOGEE (CREEK) NATION SUMMER YOUTH WORK PROGRAM

AGREEMENT

NOTICE: Please read the following carefully before signing. This is a legal document that mayaffect your legal rights.

This Agreement executed on this day of 20 , by

a third party beneficiary of services, (hereinafter" Beneficiary") provided by participants from the

Muscogee( Creek) Nation Summer Youth Work Program( hereinafter" Program"), and The Muscogee

Creek) Nation Department of Employment and Training( hereinafter" Nation").

In consideration of the Nation permitting participation in the Summer Youth Work Program, the Nation

and Beneficiary agree on behalf of himself/herself and their respective corporations or entities, to the

following terms:

1. The Muscogee( Creek) Nation will pay the Youth Participant directly and inaccordance with the( Creek) Nation policies and procedures for work performed

during the course of the Program for the benefit of the Beneficiary.

2. Beneficiaries shall be responsible for all oversight including ensuring that

Participants not perform any acts prohibited under Title 29 Code of FederalRegulations Part 570 Subpart C, Child Labor Regulation No. 3., a copy of which islocated at http:// www.dol.gov/ whd/ regs/compliance/childlabor10 text. htm# 1.

3. Beneficiaries shall monitor Participant during the time the Participant is providing

labor for Beneficiary. Furthermore, Beneficiary shall be responsible for any and alldamage to any property caused by Participant while performing labor under thisAgreement.

GOVERNING LAW: This Agreement shall be governed by the laws of the Muscogee( Creek) Nation.PARTICIPANT AND GUARDIAN HEREBY ATTEST THAT THEY HAVE READ THE

CONTENTS OF AGREEMENT AND FREELY, VOLUNTARILY AND WITHOUT DURESS

EXECUTE THE AGREEMENT.

Principal Chief Date

Beneficiary or Representative( Signature) Date

Business Name Date

M rte:.Muscogee( Creek) Nation b `, i p

Department of Education& Training Z

Employment& TrainingSummer Youth tr q 1,4,.

Employment Program i =1;' .

p

CAREER CLUSTERS

Agriculture, Food& Natural Resources—The production, processing, marketing, distribution, financing, and development of

agricultural commodities and resources including food,fiber, wood products, natural resources, horticulture, and other plant and

animal products/ resources.

Architecture& Construction—Careers in designing, planning, managing, building and maintaining the built environment.

Arts, A/ V Technology& Communications-- Designing producing, exhibiting, performing, writing, and publishing multimedia content

including visual and performing arts and design, journalism, and entertainment services.

Business Management& Administration—Careers in planning, organizing, directing and evaluating business functions essential to

efficient and productive business operations.

Education& Training-- Planning, managing and providing education and training services, and related learning support services such

as administration, teaching/ training administrative support, and professional support services.

Finance—Planning and related services forfinancial and investment planning, banking, insurance, and business financial

management.

Government& Public Administration—Planning and executing government functions at the local, state and federal levels, including

governance, national security, Foreign Service, planning, revenue and taxation, and regulations.

Health Science-- Planning, managing, and providing therapeutic services, diagnostic services, health informatics, support services,

and biotechnology research and development.

Hospitality& Tourism—Preparing individuals for employment in career pathways that relate to families and human needs such asrestaurant and food/beverage services, lodging, travel and tourism, recreation, amusement and attractions.

Human Services—Preparing individuals for employment in career pathways that relate tofamilies and human needs such as

counseling and mental health services, family and community services, personal care, and consumer services.

Information Technology—Building linkages in IT occupations for entry level, technical, and professional careers related to the design,development, support and management ofhardware, software, multimedia and systems integration services.

Law, Public Safety, Corrections& Security—Planning managing, and providing legal, public safety, protective services and homeland

security, including professional and technical support services.

Manufacturing--Planning, managing and performing the processing of materials Into intermediate or final products and relatedprofessional and technical support activities such as production planning and control, maintenance and manufacturing/process

engineering.

Marketing—Planning managing, and performing marketing activities to reach organizational objectives such as brand management,

professional sales, merchandising, marketing communications and market research.

Science, Technology, Engineering& Mathematics—Planning, managing, and providing scientific research and professional and

technical services( e.g., physical science, social science, engineering) including laboratory and testing services, and research and

development services.

Transportation, Distribution& Logistics—The planning, management and movement ofpeople, materials, and goods by road,

pipeline, air, roll and water and related professional and technical support services such as transportation infrastructure planning

and management, logistics services, mobile equipment andfacility maintenance,

Muscogee( Creek) Nation Tribal Complex• P. 0. Box 580• Okmulgee, Oklahoma 744471- 800-482- 1979. 918-732- 7777• Fax 918-732- 7696• eta@mcn- nsn.gov

STATE OF OKLAHOMA

unr1...-“ ILD LABOR LAW

Section 71 et. seq. ofTitle 40 ofthe Oklahoma Statutes

Applicable to minors UNDER 16 years of age

Minimum Age 14 years of age

Employment Employment certificate is issued by the school and is required for all employedminors, including home schooled minors and minors from out-of-state working in

Certificate Oklahoma.

Employers are required to have an employment certificate from the school beforea minor is allowed to work.

Note to Issuing Officer(s): Minors must comply with compulsory SchoolLaws, Title 70 Section 10

Hours Standard School in session— minors restricted to:

No more than three( 3) hours per school dayNo more than eight( 8) hours per non- school dayNo more than eighteen( 18) hours per school week

School not in session-- minors restricted to:

No more than eight( 8) hours per non-school dayNo more than forty( 40) hours per non- school week

Break Periods For every five( 5) hours worked— Thirty( 30) minute rest periodFor every eight( 8) hours worked—One( I) hour rest period

Times Standard From Tuesday after Labor Day through May 31'— minors:

Can not work before 7:00 a.m. and not after 7: 00 p.m.

From June 1C

through Labor Day— minors:

Can not work before 7: 00 a.m. and not after 9: 00 .. m.

Prohibited Occupations which threaten health and well-being include, but not limited to:

Baking Communications Construction

Occupations Cooking Coolers CuttersDemolition Freezers FryersGrilb Hoisting devices Ladders

Loading Machinery ManufacturingMining Motor vehicles MowersPower-Driven Processing Public messengerPublic Utilities Repair SlicersStorage Transportation UnloadingWarehouse Weed eaters Work rooms

Youth peddling

For information on hazardous occupations for 16 and.17 year olds, contact

the United States Department of Labor at 1- 866-487- 9243

Oklahoma Department of Labor

1- 888- 269- 5353

www.labor. ok.gav