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Name
*
First
Last
Business Name
*
Business Address
*
Please enter ONLY the street address. For “example” (123 main street)
Email
*
Contact Number
Industries
— Select Choice —
Production Worker
Hospitality
Child Care Provider
House Keeper
Clerical
Option Industries Pay
Other
Placement Option
*
—Select Choice—
Temp-To-Hire
Direct Hire
Temporary
Number of Workers
*
1-3
4-9
10+
Hourly Pay Rate
*
Per-Worker (minimum wage for Ohio is $11.00 per hour)
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