Employer Job Order Form

Company Information    Phone Number:
Name:   Fax Number:
Company:   Email:
Street Address:   Website:
City:   Zip Code:

Position Information Job Title:   Number of Openings:
Start Date:   Starting Wage:
Hours Per Week:   Benefits: Yes  No

Shift Day   Swing   Grave  

Days of Week Monday    Tuesday    Wednesday    Thursday    Friday    Saturday    Sunday

Duration Full Time   Part Time   Permanent   Temporary

Referral Instructions (Check all that apply) Call for appointment  Apply in Person  Send Resumé Online  Fax Resumé  Mail Resumé

Job Duties
(Work performed, equipment, methods, materials, physical activity, maximum lifting, time standing, etc.)

Qualifications/Working Conditions/Information
(Previous experience, education, work equipment, opportunities for promotion, transportation, etc.)