EMPLOYER JOB REQUEST INPUT FORM     (DES-514)

If you do not wish to use the Internet E-mail you may:

1. Print this form and mail (USPO) to – 1610 University Avenue, Suite 106 - Knoxville TN 37921

2. Copy file to disk and mail (package service) to - 1610 University Avenue, Suite 106 - Knoxville TN 37921

3. Print this form and FAX information to 865-594-6266

Please note: Job order requests regarding Alien Labor Certification(s) must be posted through:

http://www.tennessee.gov/labor-wfd/overview/alien.htm

Please provide the following information:

Company Name (Required)
Street Address (Required)	(123 Main St)
Postal Address (Required)	(PO Box 123)
City (Required)
State (Required)	(xx)
Zip Code (Required)	(xxxxx-xxxx)
County (Required)
Office Phone (Required)	(xxx-xxx-xxxx-ext)
Other Phone (Optional)	(xxx-xxx-xxxx)
FAX (Optional)	(xxx-xxx-xxxx)
E-mail (Optional)

Employer is a Federal Contractor (Required):     Yes No

Occupational Title (Required)
Contact/Whom to See (Required)
Contact Phone (Required)	(xxx-xxx-xxxx)
Months Experience (Required)	(xx)
Minimum Age (Required)	(Must be 40 or lower)

Education (Required) (Highest Grade Completed):

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Degree/Certification (Optional)

(Bachelor's, CPA, Architect, Dental Assistant)

Applicant Testing Required (Optional)     Yes No

If Yes - Test Administered By     Employer     Job Service     Other

Number Openings (Required)
Number to Refer (Optional)

Job Duration (Required)     

Full Time     1-3 Days (Day)     4-150 Days (Temp)     Over 150 Days (Perm)

Part Time     1-3 Days (Day)     4-150 Days (Temp)     Over 150 Days (Perm)

Pay Range (Helpful)	($/Hr, $/Wk, $/Mo, $/Yr, Commission, Piece Rate, etc)
Other Pay (Helpful)	(401K, Bonus, Paid Insurance, etc)

Hours/Week (Required)
UI Tax# (Helpful)	(xxx-xxxx)

Job Summary:

Duties, Hours, Days, Remarks, Special Requirements(Helpful)

Line 1
Line 2
Line 3
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Referral Instructions
Other Information