Workforce Funding Application - Maine Community College System

PART A: COMPANY INFORMATION

Company Name

Address

Street Address Mailing Address if different from Street Address City State ZIP Code

Name of Designated Project Contact

Title

Phone

Extension

Email

Website

Maine incorporation date

Company description

Provide a brief description of the company and the goods/services produced, or upload a file with this information.

Max. file size: 50 MB.

Number of Employees

Number of company employees working at Maine facilities. Provide information for the current year and the last two years. If needed, add a new row to add previous years.

Year	# Seasonal Employees	# Part-Time Employees	# Full-Time Employees

Year	# Seasonal Employees	# Part-Time Employees	# Full-Time Employees

Number of additional full-time employees the company expects to hire within the next year:

PART B: TRAINING REQUESTED

Number of Maine residents for which training is requested:

Trainee Employment Info

Enter information on trainee positions or attach a list with the information below.

Trainee job title(s)	# of trainees	Hourly wage	Wage change after training	# Hours of work per week	Pre-hire, post or incumbent

Attach a list of trainee employment info if more space is needed.

Max. file size: 50 MB.

Describe anticipated hiring schedule (if applicable) and desired training schedule (start & end dates, # of hours):

Capital investment

Company's anticipated capital investment for workforce expansion.

Increase in payroll

Indicate the company's anticipated increase in annual payroll.

Health insurance

Percent of company's payment of employee health insurance premiums.

Employee benefits

Indicate when benefits become available to employees.

Economic and productivity gains

State the public benefits for using taxpayer dollars to fund the training described in this application. Enter statement here and/or check all that apply in the checklist below.

Economic and productivity gains

State the public benefits for using taxpayer dollars to fund the training described in this application. Check all that apply.

Improve company competitiveness
Improve employee retention
Improve employee credentials
Increase payroll taxes paid to the State
Improve company productivity
Increase wages for trainees
Increase job security/job retention in Maine
Other

PART C: DOCUMENTATION

The following information is required.

Annual Report

If an annual report is not available, please attach another financial document such as latest tax return, auditor's statement, or a list of financial references as evidence of financial condition.

Max. file size: 50 MB.

Employee benefits

Employee benefit package information & health insurance options detail.

Max. file size: 50 MB.

Additional Information

Please attach any additional information you feel should be considered as part of this application.

Max. file size: 50 MB.

Read the Terms and Conditions. (We recommend that you print a copy for your records.)

Acceptance of TERMS AND CONDITIONS

Acceptance of terms and conditions*

By submitting this application, the Company and/or its agents have read and accepted the Terms and Conditions listed above.

Name of authorized signature

Title

Company

Date