No Cost Placement

Job Order Data Entry Form
(*Required Fields)
Federal ID #: CA Tax ID#
Business Name: *
Contact Name: *
Title:
Business Address: *
City: * State: Zip Code: *
Mailing Address:
City: State: Zip Code:
Phone # * Ext.
Fax #
E-mail: *
Web Site:

How did you hear about Build WorkSource Center?

Have you used our services before? YES NO
If no, reason:

If yes, contact name:
Business Industry:
# of Employees:
Corporate/headquarters
Branch
# of Employees at this location

Recruitment methods: Referral Promote within Agency
CalJOBS Advertise

Peak hiring cycles: No Yes
Winter Spring Summer Fall

Benefits:
Yes No
Medical Dental Vision Retirement
Life Ins. Profit Sharing Other

Shift: Day Evening Swing Graveyard
Flex Other:

Openings:

Job Title 1:
Duties/Skills:

HRS/WK Salary:

Job Title 2:
Duties/Skills:

HRS/WK Salary:

Job Title 3:
Duties/Skills:

HRS/WK Salary:

Notes:

Referrals:

All information given is kept confidential. None of your information will be sold or distributed to any second parties without your permission.