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How did you hear about us?
Have you listed with other Workforce Centers?		Yes __ No
Federal ID #		Type of Business
Employer Name
Address
City		State ___ Zip
Phone Number		Fax Number
Email Address
Whom Should the Job Seeker Contact?
Title of Job Opening
# of Openings		Min. Age
Full Time/Part Time Full Time (30+ hours) Part Time (29 hours or less) Both Available
Perm/Temp Permanent-over 150 days Temporary-4-150 days Seasonal (weather related) Temporary to Permanent
Work Days: Mon _Tues _Wed _Thurs _Fri _Sat _Sun
Months of Experience Required
Education Required 00- None 01- First Grade 02- Second Grade 03- Third Grade 04- Fourth Grade 05- Fifth Grade 06- Sixth Grade 07- Seventh Grade 08- Eight Grade 09- Ninth Grade 10- Tenth Grade 11- Eleventh Grade 12- HS Diploma Only 13- Some College(1yr) 14- Associate's (2yrs) 15- Some College (3yrs) 16- College Grad/Bachelor's (4yrs) 17- Post College 18- Master's 19- Doctorate's 20- GED or HS Diploma
Are Trainees Considered?		Yes __ No
Degree Required?:		Yes __ No
If Degree Required, Please List What Degree
Occupational License(s) Required? (CNA, RN, HVAC, Plumbing, etc)
Starting Salary___ $ .		per Hour Day Week Two Weeks Month Year
	If Salary is Negotiable, Please List Range
	$ . to $ .		per Hour Day Week Two Weeks Month Year
Hours Per Week __
Over Time Required? __ Yes __ No
Type of Driver's License Required: None Regular, Private (Class R) CDLA Only (Commercial Driver Class A) CDLB Only (Commercial Driver Class B) CDLC Only (Commercial Driver Class C) CDLA or CDLB
Endorsements Required: Tanker __Triples/Doubles __Hazmat __Passenger
CDL Driving: Over The Road Driving Required? __ Yes __ No __N/A
CDL Driving: Team Driving Required? __ Yes __ No __N/A
Do you consider non-English Speakers? __ Yes __ No __
Do you consider ex-offenders? __ Yes __ No __
Background Check Required?__ Yes __ No __
Drug Test Required?__ Yes __ No __
Dress Code Required? __ Yes __ No _PPlease Specify:
Benefits Offered? __ Yes __ No __Please Specify: