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Pennsylvania Way to Work
Employment Interest Notification Form
Pennsylvania Way to Work is an innovative program designed to stimulate job growth and the economy. Through this program, employers can hire employees and have 100 percent of their gross wages covered up to $13 an hour! This program is available through September 30, 2010.

If you are an employer interested in participating in Pennsylvania Way to Work, please complete the Employment Interest Notification form. Please use a separate form for each different type of position you want to list, but you may use one form if you have multiple openings for the same position with your business.

Please read over the form and make sure it is complete. Then click the submit button. If email is not an option available to you, the form can be faxed to 610-437-3527.

Once your form is received, you will be contacted by a representative to discuss your interest in the program.
Today's date:
Name of your company:
Company website address: http://
Address where your company is located:
Street
City
State
Zip Code
County
Is the job location address the same as the company address?
If no, please provide job location address:
Street
City
State
Zip Code
County
Is public transportation available to the job location?
Interview address is same as:
If neither, please provide the interview address:
Street
City
State
Zip Code
County
What is the primary interview contact person for this job?
Name
Telephone
Fax
Email
What is the job title?
how many job openings are available?
How many people would you like us
to refer to you?
What are the work hours of this position?
Is any experience required?
  If yes, please provide months/years
  experience:		Months
Years
What is the minimum level of education
required?
What is the starting hourly wage
of this position?
Is there a job-related minimum
age requirement?
If yes, please provide the age and
job-related reason:
Is there a job-related driver's
license requirement?
If endorsements are required, select all that apply:
If screenings are required, select all that apply:
Is there a collective bargaining
unit at this employer?
Are there any required skills or qualifications for this job? (Limit 500 characters including spaces)
Are there any skills or qualifications you prefer, but are not required? (Limit 500 characters including spaces)
What are the job duties associated with this position? (Limit 500 characters including spaces)
Name of person submitting this notification: (If different from the interview contact person)
Name
Telephone
Fax
Email

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