Job Order Form

2. Date
   Date

3. Federal ID

   Please include your Federal ID if you would like this posted to the NYS Job Bank.

5. Business Name*

6. Mailing Address

8. Telephone*

9. Fax

10. Email*

12. Contact Person/Title*

14. Job Title*

15. Job Location*

17. Number of Openings

18. Full or Part Time

    1. Full Time
    2. Part Time

19. Work Days per Week

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
    6. Saturday
    7. Sunday

20. Shift

    1. First
    2. Second
    3. Third
    4. Varies

22. Wage

23. Per (Hour/month/year)
    -- Select One --HourMonthYear

25. Job Description*

27. How should applicant apply?*

    Brief description of how someone who is interested in this position should apply. Please include link or email if applicable.

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field