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.