joborderrequestform »

WC Worcester
508-799-1600

WC Milford
508-478-4300

In order to provide you with better service, please take a few minutes to complete this form.
Submission of this form will automatically send your information to Workforce Central Career Center.

To whom at WC would you like this information sent? Please select a business service representative to receive your "Job Order Request Form".

Is this position available as a result of the American Reinvestment and Recovery Act?
Is this position represented by a union?

Yes No
Yes No

Company Information
Company Name
Address
City
State
Zip
Main Telephone Number
Web Address
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 (e.g., ESOL, Adult Education) Uniforms Furnished Vacation Leave Vehicle Furnished Vision Insurance Other (Please specify)

Contact Information
Contact Name
Title
Telephone (including extension)
Fax
E-mail Address

Job Information

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 AM PM
To AM PM

Pay Range
(Please note that WC cannot perform an automated job match on this job without pay information)

Minimum Per
Maximum Per
     Plus Commission
     Plus Tips
     Bonuses

Job Description / Duties
(copy and paste into the text area)

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

words per minute keystrokes per hour

How do you want referrals to contact you?
(Check all that apply)

Phone	E-mail
Mail	Walk-in
Fax	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

If you have multiple job order requests, fill out and submit a Job Order Request Form for the first job. Then use your browser Back button to return to the form. Your original submitted information will still be displayed in the form, and you only need to change those fields where different information is needed. Then submit the form for the second job. Continue this process until all job order requests have been submitted.

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 that you submitted the Job Order Form to

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WC Worcester
508-799-1600

WC Southbridge
508-765-6430

WC Milford
508-478-4300

Page last updated on September 20, 2010