Employer Name

Employer ID Number

Telephone

Email

Cell

FAX

Number of Openings

How many candidates should we refer to you for this position

How to contact/refer

Call First        Email Resume
FAX Resume   Mail Resume
Send Direct    No Calls Please

Yes

Job Title

Job site location

Position is

Full Time Part Time

Duration

1-3 days 4-150 days
Over 150 days

Shift (ex 9-5)

Days to Work

Mon Tues Wed Thurs
Fri     Sat   Sun

Hours Per Week

Minimum Pay

Maximum Pay

Pay Unit: Hourly

Annually

Other (ex. salary commensurate with experience)

Months Experience

Education

Minimum Age

Occupational License

Yes

Drivers License

Is there access to public transportation?

Yes

Benefits Offered

Health Insurance

Dental Insurance

Retirement Plan

Long Term Disability

Vision Insurance

Vacation Leave

Sick Leave

Mileage Reimbursement

Uniforms

Other (Please specify below)

Job Description/Summary
(cut and paste here)