Job Listing Request Form

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To help you fill positions for your company you will need to fill out the Job Listing Request Form. This form gives us all the pertinent information to assist you in finding the qualified candidate for your position. Once you send us this form, the job information will be posted in paper form at our career centers, and on the following websites:

Specific instructions for completion of this form are as follows:

Complete the form below and click on the "Save" button to send your information to Workforce Central.
After successfully submitting your information, you will be redirected to a confirmation web page that displays the results of your submission.
If you have multiple job order requests, please fill out and submit a Job Order Request Form for each request.

You will receive confirmation when this job order is posted. This will include the job order number, and how to review your job order on the DCS, and AJB websites. If you do not receive confirmation within three (3) business days, please contact one of our Business Service Representatives.

This service is provided at no cost to you. It is important that you track your referrals and interviews to provide us with feedback. Your feedback will help us increase the effectiveness of this service. When any individuals are hired for this position please contact the Business Service Representative to which you submit the Job Order Form.

To *	Please select a business service representative to receive your "Job Order Request Form".
Is this position represented by a union?	Yes No
Company Name
Address
City
State
Zip Code
Main Telephone Number
Website
FEIN (Federal Employer Identification Number) and Product Line
Company Benefits Available For This Job (Please Check All That Apply)	No Benefits 401K Bonuses Child Care Referral Resources Child Care Services Reimbursement Clothing Allowance Dental Insurance Education Cost Reimbursement Employee Discount In-House Skills Training Programs Life Insurance Long-Term Disability Major Medical Mileage Reimbursement On-Site Child Care Paid Holidays Prescriptions Retirement Plan Short-Term Disability Sick Leave Subsidized Skills Development Uniforms Furnished Vacation Leave Vehicle Furnished Vision Insurance Other
Contact Name *
Title
Telephone	(Include Extension if Appropriate)
Fax
Email Address *
Is the job location different from the company location?	Yes No
If yes, where is the job location? (Please Enter At Least Town and Zip Code)
Is public transportation available to the job location?	Yes No
Job Title
Number of Openings
Duration
If temporary, please specify length
Shift
Hours Per Week
Work Hours (From - To)
Pay Range (Please note that WC cannot perform an automated job match on this job without pay information.)	(Example: $8.25 per hour - $9.50 per hour)
Pay Extras	Plus Commission Plus Tips Bonuses
Job Description/Duties *
Required Amount of Experience
Required Skills (e.g., Computer, Languages, Specific Job Skills)
Is there a minimum age requirement, based on applicable laws?	Yes No
If yes, what is the minimum age for this job?
Required Education
In what field?
Driver's License Required?	Yes No
If yes, what type?
Are background checks required (e.g., CORI)?	Yes No
If yes, please specify
Is drug testing required?	Yes No
Is a physical required?	Yes No
Desired Keyboard Speed	(Example: 50 words per minute)
How do you want referrals to contact you? (Check All That Apply)	Phone Mail Fax Email Walk-In No Phone Calls
Specific Referral Instructions
Would you like to receive information about on-site recruitments and job fairs at Workforce Central?	Yes No
This job order will be posted for 30 days unless otherwise noted here:
Enter text exactly as it appears in the image.

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