Assessment Form

County:
Name of Company:
Contact Name:
Address:
City: State:
Zip: Phone:
FAX: Email:
Web Site:
Date Completed:
 
Type Of Business:













Other:
 
Is your business locally owned? If no, explain:
 
How many employees work at this establishment? Full Time:
Part Time:
Seasonal:
 
List positions employed in your firm (e.g. payroll clerk, cashier, assembler) and starting wage(OPTIONAL): Position 1: Starting Wage: $ 
Position 2: Starting Wage: $ 
Position 3: Starting Wage: $ 
Position 4: Starting Wage: $ 
Position 5: Starting Wage: $ 
 
Benefits:







Other:
 
Is there a cost to employees for any benefits offered? If yes, explain:
Is your business unionized? If yes, what unions:
 
Comments:
 
Within the next 5 years, do you expect your workforce to:
 
If the number of employees is expected to change in the next 5 years, what are the main reasons for the change? (Please check all that apply):
















Other:
 
Does your business have difficulty recruiting employees? If so, please check all that apply:




Other:
 
What method(s) do you use to recruit new employees? (Check all that apply)




Other:
 
What are the causes for employee turnover?








Other:
 
What type of information or services would you like to see our center offer to the local business community? (Check all that apply)




   







Other Workshop:





Other Services: