Employer Intake Form - WCC Employment Research Study

For the following questions please provide a minimum of two contacts for your organization. Suggested contacts would be; business owner, office manager(s), HR representative.

When a survey is released the Primary contact will be notified. If there is no response from that individual then the secondary staff member will be contacted.

Please contact Amanda Porter with any questions.

amanda@springfielddevelopment.org

802-885-3061

Question Title

* 1. Please enter the following information.

Business/Organization Name

Business Mailing Address

Business Phone

Question Title

* 2. Please enter the following information for Primary Contact.

Contact Name

Job Title/Position

Primary Phone Number

Email Address

Question Title

* 3. Please enter the following information for Secondary Contact

Contact Name

Job Title/Position

Primary Phone Number

Email Address

Question Title

* 4. Please enter the following information for additional contact (optional)

Contact Name

Job Title/Position

Primary Phone Number

Email Address