Employer Registration Question Title * 1. Company / Organization Name Question Title * 2. dba (Doing Business As) if applicable Question Title * 3. Business Type Private (for profit) Public (Government Agency) Non-Profit Non-Profit w/ Religious Affiliation Question Title * 4. Address Street City State Zip Code Question Title * 5. Does your company have multiple locations? Yes No Question Title * 6. Contact Persons Name Question Title * 7. Contact Persons Title Question Title * 8. Contact Info Primary Phone # Email Address Company Website Question Title * 9. Number of Employees 1-10 11-50 51-100 101 + Question Title * 10. Federal ID Number Question Title * 11. Have you used our Goodwill Job Connection Centers in the past? Yes No Question Title * 12. Which Job Connection Centers are you currently OR would like to be working with? (check all that apply) Apopka Clermont Daytona Beach DeLand East Orlando Kissimmee Leesburg South Orlando West Melbourne West Orlando West Sanford Question Title * 13. Industry Sector (please check only one industry sector which your company does business) 11 - Agriculture, Forestry, Fishing and Hunting 21 - Mining 22 - Utilities 23 - Construction 31 - Manufacturing 42 - Wholesale Trade 44 - Retail Trade 48 - Transportation and Warehousing 51 - Information Technology 52 - Finance and Insurance 53 - Real Estate and Rental & Leasing 54 - Professional, Scientific and Technical Services 55 - Management of Companies 56 - Administration, Support, Waste Management & Remediation 61 - Education Services 62 - Health Care and Social Assistance 71 - Accommodation and Food Service 81 - Other Services 92 - Public Administration 99 - Unclassified Establishments Done