* 1. Company Name

* 2. Contact Name

* 3. Phone Number

* 4. Please select the Ohio targeted industry identified by your company's NAICS code.

Please answer the following questions about the employees you want to train.

* 5. Are the employees located within Ohio?

* 6. Please indicate the employees' business function. Check all that apply.

* 7. Do all of these employees earn at least $10.88/hr. plus benefits? (150% of Ohio Minimum wage as of Jan. 1, 2012)

* 8. Are these employees Ohio residents?

* 9. Are these employees at least 18 years old?

* 10. Do the employees work at least 25 hours per week?

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