Date: _______________ Employer_________________________ Telephone: _________________ Address__________________________ City_____________________________ State____________________________ Zip______________________________ Nature of business______________________________________________ Position to be filled___________________________________________ Employee qualifications_________________________________________ Number of employee’s needed______________________________________ Wages or salary ________________ per __________________________ Employment is _____temporary ______permanent Hour’s ________ to _______ Day’s ___________ to __________ Benefits________________________________________________________ We are an equal opportunity employer.