Incumbent Worker Training Program Questionnaire Form

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(*) Entry Required

1. * What is the registered name of your company?
   
   
2. * Have you been in business in Louisiana for three years?
   Yes   No  
   
3. * What region of the state are you located in?
   Choose one... Central Capital Bayou Acadiana Southwest Northeast Southeast Northwest
   
   
   Avoyelles, Catahoula, Concordia, Grant, LaSalle, Rapides, Vernon, Winn
   
   Ascension, E. Baton Rouge, E. Feliciana, Iberville, Livingston, Pointe Coupee,
   St. Helena, Tangipahoa, Washington, W. Baton Rouge, W. Feliciana
   
   Assumption, Lafourche, Terrebonne
   
   Acadia, Evangeline, Iberia, Lafayette, St. Landry, St. Mary, St. Martin, Vermilion
   
   Allen, Beauregard, Calcasieu, Cameron, Jefferson Davis
   
   Caldwell, East Carroll, Franklin, Jackson, Madison, Morehouse,
   Ouachita, Richland, Tensas, Union, West Carroll
   
   Jefferson, Orleans, Plaquemines, St. Bernard, St. Charles, St. James,
   St.John the Baptist, St. Tammany
   
   Bienville, Bossier, Caddo, Claiborne, Desoto, Lincoln, Natchitoches,
   Sabine, Red River, Webster
4. * Have you been paying into the unemployment trust fund for three years?
   Yes   No  
   
5. * What is your unemployment insurance tax #?
   
   
6. * How many employees are in your company?
   
   
7. * Briefly tell us what your project is about including any details
        (dates, times, contact info, etc.)
   
   Character Count: (Max 500, remaining 500.)
8. * Will this training result in a wage increase for these individuals?
   Yes   No  
   
9. * Your Name.
   
   
10. * Your Phone Number.
    
    
11. * Your Email Address.
    
    

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