Fair Chance Hiring Employer Interest Form

Name of your Business* This field is required.

Business Address.* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

Business Contact Person Name.* This field is required.

Business Contact Person TitleExample: HR Manager, CEO, Owner, Operations Manager, etc.

Phone Number* This field is required.

Email* This field is required.

example@example.com

Preferred Contact Method* This field is required.

Phone

Are you a federal contractor?* This field is required.

YESNO

What size is your business?* This field is required.

Small sized business (1-50 employees)

Medium sized business (51-99 employees)

Large sized business (100+ employees)

Which sector is your business in?* This field is required.Choose the sector that most closely matches your business. If your sector is not on this list, select “Don’t see your sector?” and enter your sector manually. Bonus points if you know your NAICS code.

UTILITIES (INCLUDING GREEN ENERGY) (NAICS: 22)

MANUFACTURING (INCLUDING ADVANCED MANUFACTURING) (NAICS: 31-33)

RETAIL TRADE (NAICS: 44-45)

INFORMATION (NAICS: 51)

HEALTHCARE AND SOCIAL ASSISTANCE (NAICS: 62)

ACCOMMODATION AND FOOD SERVICES (NAICS: 72)

CONSTRUCTION (NAICS: 23)

WHOLESALE TRADE (INCLUDING LOGISTICS) (NAICS: 42)

TRANSPORTATION AND WAREHOUSING (NAICS: 48-49)

PROFESSIONAL, SCIENTIFIC, AND TECHNICAL SERVICES (NAICS: 54)

ARTS, ENTERTAINMENT, AND RECREATION (NAICS: 71)

Other

How many participants are you interested in hiring?* This field is required.Tell us how many system impacted individuals do you see yourself hiring.

Would you be willing to hire candidates from LA County for remote work?* This field is required.

YESNO

Which state would you be willing to hire remotely located candidates from?

State

Country

Are you interested in obtaining WIOA Business services?* This field is required.

YESNO

Would you like to be designated as a Fair Chance Employer?* This field is required.

YESNO

Can we display your organization / company as a Fair Chance Employer?* This field is required.

YESNO

Briefly describe the types of roles your organization may be able to offer to our Job Seekers* This field is required.This can be a role that you do not yet have but are looking to fill with a qualified candidate from this program

Ex: Office administration, Marketing, Sales, Human Resources, etc

Please describe any essential skills or considerations you are looking for in a job seeker* This field is required.This will help us identify the ideal candidate for this position

Example: Writing Skills, Communication Skills, Sales Skills, Business Operations Skills, Event Planning Skills, etc.

Please indicate if these positions are in-person, remote work, or hybrid* This field is required.

How did you hear about the program?* This field is required.

Fair Chance Hiring Employer Interest Form