Company Name:

Street Address:

City:

State:

Zip Code:

Phone:

Fax:

Email:

Website Address:

Nature of Business:

Contact Person:

Starting Date:

Number Hiring:

Job Title:

Job Duties:
(brief description)

Minimum Requirements:
(i.e., high school diploma, GED, must lift 50 lbs., driver's license)

Application Process:

Beginning Wage:

Company Paid Benefits:

Work Schedule:
(days/hours)

Work Hours:

Would you consider referrals who require additional training if you were reimbursed for a portion of your costs of the training?



Yes     No

Questions or Comments: