Learn, Work, Train - Cape Atlantic One Stops

Atlantic and Cape May County's
One Stop Career Centers

(COMPLETED BY EMPLOYER FOR PRE-AWARD DETERMINATION)

Please provide the following information if your business/company is interested in participating in an On-the-Job Training program.

*Required Fields
Employer/Company Name:	*
Federal Employer ID Number:	*
Primary County where business is located?
Contact Person:	*
Title:
Email:	*
Confirm Email:	*
Address:	*
City:	*
State:	*
Zip:	*
Phone Number:
Fax Number:
Organization product or service:

	IMPORTANT: DO NOT INCLUDE ANY WEB LINKS!
Please include my email address when sending information regarding FREE training and other business related events.
Number of full-time employees:
Number of part-time employees:
Hours of Operation:
Employee benefit package:
Does the company now or previously operate under any other name(s), if so please list:

Has the company operated under previous ownership? Yes No
If yes, when did the most recent sale take place?
Is the company a subsidiary of any other ogranization? Yes No
If yes, name the organization:
Does the company have any subsidiaries? Yes No
If yes, please list the subsidiaries:
Has the company or any of its subsidiaries or division, relocated or closed any of its operations within the last 120 days with the following results:
Cessation of business operations: Yes No
Voluntary separation due to potential relocations: Yes No
Layoffs: Yes No
If yes, please explain (including dates) how these changes occurred and at what locations: