Fillable BUSINESS SERVICE REQUEST FORM (DeKalb County Government)

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BUSINESS SERVICE REQUEST FORM (DeKalb County Government)

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WorkSource DeKalb is an equal opportunity program. Auxiliary aids/services are available upon request to individuals
with disabilities. Persons with hearing impairments, all voice telephone numbers may be reached using TTY/TDD
equipment via the Georgia Relay Services at 1-800-255-0135. WSD is fully funded by the U. S. Department of Labor and
is a proud partner of the American Job Center Network.
BUSINESS'SERVICE'REQUEST'FORM'
Please#complete#this#form#for#each#position#that#you#have#available.#
FEDERAL'TAX'ID:'
WEBSITE:
DATE:________________________ '''
COMPANY#NAME: ___________________________#
ADDRESS:__________________________________###
(WORKSITE#ADDRESS#IF#DIFFERENT):#______________________________________
CONTACT#NAME:____________________________________________________###
CONTACT#PHONE:___________________________________________________###
CONTACT#E-MAIL# ADDRESS:___________________________________________###
Are#you#a#private#employment#agency# or#staffing#agency?#
#YES# #NO#
Other#
SEASONAL#
JOB#DESCRIPTION:##(Please'include'a'copy'of'the'Job' Description)#
POSITION#TITLE:###
NUMBER#OF#POSITIONS#AVAILABLE:_________###TARGET#START#DATE:__________#
WEEKLY#WORK#HOURS:#######20-30#hours## ############ 30-40#hours##
SPECIFIC#WORK#SCHEDULE:#________________________________________
SALARY#RATE(OR#RANGE): ________________________________________###
PERM# ########### # TEMP# ########### # TEMP-TO-PERM#
PUBLIC#TRANSPORTATION#ACCESSIBILITY#######YES# ###############NO##
IF#SCREENINGS#ARE#REQUIRED,#SELECT#ALL#THAT#APPLY:#
#CREDIT# #DRUG### #MVR### # #BACKGROUND# #OTHER#____________________________#
Please#return#form#to:#
jbblack@dekalbcountyga.gov
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BUSINESS SERVICE REQUEST FORM (DeKalb County Government)

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Completed 17 July 2020

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