Company Background Form Company Information Person Filling Out This Form: Date Form Filled Out:

Company Name: Previous Company Name(if applicable):

Address: City/State/Zip: Phone:

Fax: Website: E-mail:

Website Content: DUNS:

Utility Provider 1: Utility Provider 2(if appropriate):

Utility Provider 2(if appropriate) County:

Company ID(user defined) Company ID(user defined)

Visit Priority:

Company Notes:

Company Contact(s) Contact #1

Contact Type: Company Primary Executive Company Secondary Executive Company Middle Title:

Name: Middle: Last: e-mail:

Phone: Cell Phone: Fax:

Company Contact Notes:

Contact #2

Contact Type: Company Primary Executive Company Secondary Executive Company Middle Manager Title:

Name: Middle: Last: e-mail:

Phone: Cell Phone: Fax:

Pre-Interview Conversation How long with company?(not owner) How long at this facility?(multi-facility company)

Experience prior to this position?

Education/University:

Passion 1 2 3 4 5 6 7

Parent Company Information (if applicable) Parent Name:

Address: City/State/Zip:

County: Parent Region:

Phone: Fax: Email:

CEO Name: Title: Website:

Parent Notes:

Parent Company Contacts Parent Company Primary: Parent Company Secondary: Title:

Name: Middle: Last: E-mail:

Phone: Cell Phone: Fax:

Parent Contact Notes:

History Affiliation to parent company: Subsidiary Division Branch

Year Business was established: Year Company Established in Community: Beg. of Fiscal Yr(Mth)

Type of Facility(Please check all that apply) Headquarters Division Office operation Branch Plant Distribution/Warehouse Manufacturing R&D Type of Ownership(Please check one) Public Employee-Owned Private Family Native American Not-for-Profit State government Federal government Foreign Owned

Products/Services Primary Products/Services:

Component Finished Product Both

If known, please list your NAICS (NAICS=North American Industry Classification System Code)

1) 2) 3) 4) 5)

Certification: Yes No

Comment:

Business Sector(Please check one) Advanced Manufacturing Consumer Goods Producer Energy & Energy Utilities Industrial Goods

Aeronautics and Defense Consumer Services Finance,Insurance,Real Estate Retail Related Operations

Convention/tourism Government Technology/Information

Building & Construction Diversified Health care & Pharma Telecommunications

Communications Durable goods producer High-end Business Services

Transportation

Business Sector Notes:

Local Employment Type Number

Function Number Full-Time Management:

Part-Time Technical:

Leased Sales/Marketing:

Clerical:

Production:

Total Employees: (mm/yy) Total Employees:

Date Number of jobs added or lost (-) in past 3 years: years \

Number of shifts/day:

Number of days/week:

Peak Season (Abbreviate month(s) )

Total Gross Annual Payroll: $ Employee Notes:

Union Representation

Is there union representation at your business? Yes No If yes, Name of Primary Union:

Contract expiration date (mm/yy)

Union Activity(please check all that apply) Positive working relationship Organization activities Certification Strike or lockout Arbitration Decertification

Union Notes: