Loan Referral Form - DOC by 88Xh49


									                                       Business Referral Form

Referral Information

Agency Providing Referral:                                                                    Date:

WorkSource Center—Referred to:

BusinessSource Center—Referred to:

Business Information

Business Name:                                                         Owner:
Telephone Number:                                                            Fax:
Email Address:                                                             Website:
Industry:                                                       Business Entity:

WIA Business Services Needed:

    Assistance in Hiring People with
                                           Implement Customize Recruitment             Referral to LABSC
    Completing BNA with Action Plan        Industry Focus Group                        Research
    Develop Job Description                Labor Market Information                    Resource Center Use
    HR Assistance                          Lay-off Aversion                            Speaker Services
    Identifying Career Ladders             Placement/Hire                              Tracking Employee Information
    Customized Worker Training             Rapid Response                              Other

LABSC Services Needed:

    Business Plan                          Insurance Services                          Referral to WorkSource
    Business Workshop                      Marketing Assistance                        Research
    Completing BNA with Action Plan        Microenterprise Training                    Tax Credit/Voucher Assistance
    Financing Assistance                   Procurement Assistance                      Other


Follow Up

Agency Representative:                                                                         Date:

                                        An Equal Opportunity Employer/Program.
                  Auxiliary aids and services are available upon request to individuals with disabilities.

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