JOB PLACEMENT INFORMATION

QUALITY CAREER SERVICES

2515 Wabash Avenue, Suite LL1

St. Paul, MN  55114

PHONE: (651) 647-9322        FAX (651) 647-0423

 

DATE:

 

 

GRANT NAME:

 

 

CLIENT NAME:

 

 

PHONE: 

 

 

EMPLOYMENT INFORMATION

 

COMPANY NAME:

 

 

ADDRESS: 

 

 

CITY/ZIP CODE:

 

 

PHONE NUMBER:

 

 

JOB TITLE:

 

 

STARTING WAGE

 

 

START DATE

 

 

1.)  Temporary Position:

YES

 

NO

 

 

Hours Per Week

 

or

 

2.)  Full Time 

 

Part time

 

 

Hours Per Week

 

 

IS THE POSITION TRAINING RELATED? 

YES

 

NO

 

 

DOES THE EMPLOYER PAY INTO THE MN UI TAX FUND? 

YES

 

NO

 

 

BENEFITS: 

YES

 

NO

 

 

WHAT PRODUCT DOES THE COMPANY MAKE OR WHAT SERVICES DOES IT PROVIDE?

 

HOW DID YOU FIND OUT ABOUT THIS POSITION?

 

If you have accepted full time/part time (temporary employment) or (part time employment) a letter from your employer is needed to continue dislocated worker services.

 

The letter must be on company letterhead and state if your employment is temporary or part time.   Temporary employment letter must have your ending date of employment.  If part time employment the letter must have total hours you are working per week.

 

Are you attending school? 

YES

 

NO

 

 

Date of Graduation

 

 

Planning on attending school? 

YES

 

NO

 

 

Date