Business Needs Assessment Form

How did you hear about WorkSource *

Contact Name *

Title

Business Name *

Business Street Address

City

State

ZIP

Phone *

Extension

Fax

Email Address *

Website/URL

Federal Tax ID # *

Standard Industry Code (SIC NAICS)

Company's product or service

Years in business

This is a:

# of Employees at this location

What is the most significant factor affecting your business?

Current BUSINESS ASSISTANCE needed (that could be provide through our partners or collaborators)

What changes do you foresee in the next year?

What changes do you foresee in the next 5 years?

Do you have any particular hiring needs at this time? *

If YES, may we contact you to get details? *

How can we help with your staffing needs today?

If no hiring needs, do you anticipate any over the next 6 months?

# of Positions?

Full Time?

Yes

No

Part Time?

Yes

No

Do you do the hiring?

Yes

No

If no, who is responsible?

How many openings currently?

What are the main issues when considering hiring?

Do you have any difficulty finding qualified employees?

Yes

No

If no, please describe

Any difficulty retaining qualified employees?

Yes

No

Why?

Do you hire ex-felons?

Yes

No

If yes, how extensive?

Do you provide benefits?

Yes

No

If yes, what benefits?

What type of training do you provide your employees?

Current STAFFING, TRAINING, AND HUMAN RESOURCES assistance needed (provided by WorkSource): *

Lay off/Downsizing services

Job applicants

Retention assistance

Interview/Conference room

New hire trainingNew hire training

Current employee training (topics)Current employee training (topics)

OFFICE USE ONLY (Steps recommended, referral and followup)

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Email

Language

Office

Contact Us

Hours of Operation