EMPLOYMENT INFORMATION FORM

Date:_______________

Employer_________________________    Telephone:_________________
Address__________________________
City_____________________________
State____________________________
Zip______________________________

Nature of business______________________________________________
Position to be filled___________________________________________
Employee qualifications_________________________________________
Number of employees needed______________________________________
Wages or salary $________________ per __________________________
Employment is _____temporary ______permanent
Hours ________ to _______
Days ___________ to __________
Benefits________________________________________________________

We are an equal opportunity employer.