CareerPoint - Providing Resources for Employers & Job Seekers

Job Order Form
Company Name *
FEIN Number *
Address *
City *
State *
Zip Code *
Company Contact *
E-mail Address: *
Title
Phone Number/ext. *
Fax Number
Are you a Federal Contractor? *	Yes No
Employer Type *	Private Government
How did you hear about CareerPoint?
Job Specification *	Confidential Not Confidential
Job Title *
Job Location (if different from above)
Job Description *
Job Type (check one) *	Regular Temporary Temporary to Regular
Job Classification (check one) *	Full Time Part Time Number of Openings
Job on Bus Route?	Yes No
Shift(s)	1st 2nd 3rd Rotating Split Work Hours
Typing Speed (WPM)
Driver's License (Y/N and Type)
Minimum Age
Required Certificates/Licenses/Etc.
Hours Per Week *
Days of Week	M Tu W Th F Sa Su
Starting wage/salary range *
Required Education	Preferred Education
Required Experience	Preferred Experience
Skills, education, experience applicant must have
How do you want applicant to apply? *
Close Date (30-60 days) *
Are you willing to train the right person? (i.e. someone with a good work history?)
Benefits (check all that apply)	Medical Dental Vacation Life Disability Tuition Reimbursement Other
Benefits start immediately?	Yes No Benefits start after xx amount of days? No benefits
Is this job related to funding provided by the American Recovery and Reinvestment Act (ARRA)? *	Yes No Please provide the ARRA Project ID number (if known)
Is this an Apprenticeship Position? *	Yes No
Is this a Union Position? *	Yes No
Business Account Representative:

* Required

CareerPoint 850 High Street Holyoke, MA 01040 Tel: (413) 532-4900 Fax: (413) 532-0737