Please complete the following information to register as a Older Worker Friendly Employer. Older workers seeking employment will be referred to employers who complete this registration.

Personal information you provide may be used for secondary purposes. 
[Privacy Law, Section 15.04(1)(m) Wisconsin Statutes.]

Select County Name ------------------------------------------ Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon Marinette Marquette Menomine Milwaukee Monroe Oconto Onieda Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk Sauk Sawyer St. Croix Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood

We are interested in the following (Check all that apply):

Having our company appear on the list of employers who participated in this Older Workers Friendly Employer Assessment Initiative. I understand that this list will be available on the Internet and in other locations and is intended to help job seeking Older Workers link with interested employers.

Having someone in my local area contact me with more information about older workers.

Becoming involved in activities i.e. focus groups, surveys, brainstorming sessions that address Older Workers issues at the local or state level.