Pacific Gateway Employer Registration Form
To reach a Business Services Representative, please call Cort Huckabone at (562) 570-4576 or email Cort.Huckabone@pacific-gateway.org
Is your business for-profit or non-profit?
Is your business home-based?
Business Name:
Your answer
Address:
Your answer
City:
Your answer
State:
Zip:
Your answer
Contact Person:
Your answer
Title:
Your answer
Phone:
Your answer
Email:
Your answer
Company Website:
Your answer
Federal Tax ID #:
Your answer
Company's Product or Service:
Your answer
Years in Business:
Your answer
Corporate Headquarters or Branch:
How many employees are at this location:
Your answer
What is the most significant factor affecting your business:
Your answer
What changes do you foresee in the next year:
Your answer
What changes do you foresee in the next five years:
Your answer
Do you have any hiring needs at this time:
How many positions do you need to fill:
Your answer
Full Time, Part Time, or Both:
What are the main issues when you consider hiring:
Your answer
Do you have difficulty finding qualified employees:
If yes, why:
Your answer
Any difficulty retaining qualified employees:
If yes, why:
Your answer
Are you interested in any of the following services:
Questions/Comments:
Your answer
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