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					            Job Posting Form
            btworks@labor.state.ny.us
            Broome-Tioga Workforce New York
            171 Front Street
            Binghamton, NY 13905
            Telephone: 607-778-3006
            Fax: 607-778-3011

         Please fill out one Job Posting Form for each job title and submit on-line, email, fax or call to the One-Stop listed above to place your order.

                                                               EMPLOYER INFORMATION


Date:                                                                          Unemployment Registration No.

Business Name:

Street Address:                                                                City                             State                     Zip

Mailing Address:                                                               City                             State                     Zip

Telephone:                                                          Fax:                                   Email:

Contact Person:                                                                         Withhold business name?                     Yes             No
Referral Method:
                                        E-mail                 Fax                         Telephone             Mail                     In Person
(select all that apply)


                                                                     JOB INFORMATION

Job Title:                                                                            Job Location:
Number of job
                                                           Duration: (e.g. temporary, regular)                               Full time              Part time
openings:
Work days per week?
                                         Mon.              Tues.               Wed.              Thurs.               Fri.           Sat.              Sun.
(Check all that apply)
Shift:                                  First           Second             Third          Varies           Other         Explain:

Education required:                                                                                Experience:          Years:              Months:

Keyboarding Speed:                          wpm                                                    Public transportation:              Yes            No
Licenses/Certificates
Required:
Wage:                              Minimum Pay         $                     to Maximum Pay           $                 Per (hour/month/year)

Driver’s License:                       Yes          No                      If yes, what class and/or endorsement?

                                        Health Insurance                   Holidays                                                    Drug Screening

Benefits:                               Dental Insurance                   401K                                                        Medical Exam
                                                                                                   Other hiring
(Check all that apply)                  Vacation                           Clothing Allowance      requirements:                       Reference Check
                                        Sick Leave                         Child Care              (Check all that apply)              Own Tools
Union Affiliation:                      Yes          No                                                                                Own Car



Job Description:



Four major skills                  1.                                                                 3.
needed to perform job:
(in priority order)                2.                                                                 4.
YOUR BUSINESS MAY BE ELIGIBLE FOR TAX INCENTIVES AND/OR ON-THE-JOB TRAINING WAGE SUBSIDIES IF
YOU HIRE FROM DESIGNATED TARGET GROUPS. WOULD YOU LIKE MORE INFORMATION ON THIS SUBJECT?
                                                                                                                                          Yes           No

                                                                                                                                            Fastform2/01-13-2006