Order Request Form
Please FAX or Mail To:

Vermont Department of Labor
Contact Information: Resource Centers
Website: www.labor.vermont.gov

EMPLOYERS: Providing the information requested on this special job order form will help us understand your 
hiring needs and will assist us in locating the most suitable candidates. To give us your job order, please fill   
out this form and send it to us, or use it as a guide if you prefer to place your order by telephone.                    

COMPANY INFORMATION
Company:
Address:
City: State: Zip: -
Telephone:() Ext:         FAX:()
Federal Employer Identification No.  - 
State UI Tax ID Number:
Contact Person:
Address:
City: State: Zip: -
Telephone:() Ext:         FAX:()
E-mail:
Web site:
Company Descriptions: (Please include the goods or services your company produces.)

BASIC INFORMATION
Create a Job Order managed:           On the Internet:           By VDOL Resource Center:
                                                                                                   Allow Self Referral:   Screen Applicants:
Referral instructions:  Email Resume    Mail or Fax Resume    Send Direct    Applicant Call for Appointment
                                Resouce Center/Job Service Call Before Sending Applicant
Driver's License                     Endorsements:
        CDL Class A                      T  Double/ Triple Trailers                              
        CDL Class B                      P  Passenger Vehicle (Bus)                         
        CDL Class C                      N  Tank Vehicle                                          
        Non-Commercial                 H  Placarded Hazardous Material                 
                                                      X      Combination Tank/ Hazardous Material
Title of job opening:
Number of job openings:     Number of persons you wish to interview:
Job Location: City: State:
Required Education Level:
       High School Diploma or GED    Vo-Tech Certificate
       Associates Degree    BA/BS Degree    MA/MS Degree
Months of experience required:              Are you willing to accept a trainee? YES  NO
Will you accept related experience? YES  NO        If yes, specify:
Job is: Permanent   Temporary   (Duration: to )        Full-Time    Part-Time
Work hours: to         Check normal work days:S   M   T   W   T   F   S
Salary range: $ to     Per:                 Overtime:YES   NO
                       Pay period:  Weekly   Bi-Weekly   Monthly   Bi-Monthly

OTHER HIRING REQUIREMENTS (check all that apply)

Own Tools ............................             PC ................................
Employment Test ..................                   Word Processing......
Reference/ Security Test ........                   Spread Sheet ..........
Physical Exam.......................                   Database.................
Drug Test ..............................                   Accounting Software
Bondable ...............................                  CAD/ CADD ............
Type.......... WPM                       Windows.................
10 Key ...... Rate                        Macintosh................
Shorthand.. WPM                     Linux.........

JOB DESCRIPTION
Please provide a brief description of the job. List skills, aptitudes, equipment used or operated, special physical demands,
or special working conditions. Include the work site, if different from the address entered above. If available, please attach
a copy of the detailed job description when sending us this order.