KIRKWOOD COMMUNITY COLLEGE
INDUSTRIAL NEW JOBS TRAINING PROGRAM
(260E)
APPLICATION
PART I – Company Background Information
Legal Name of Company __________________________________________________________________
Federal ID Number _____________________________________________________________________
Length of Time in Business __________________ State and Year of Incorporation ______________________
Highest level of employment in the state of Iowa in the last 6 months_______________________________
Contact Person _______________________________ Title _____________________________________
Contact Email Address __________________________ Cell Phone Number _________________________
Phone Number _______________________________ Fax Number _______________________________
Project Address ________________________________________________________________________
Mailing Address ________________________________________________________________________
Corporate Name/Address (if different from above) ______________________________________________
Do you have multiple sites in the State of Iowa? Yes ___ No ___
(If Yes, please list the addresses)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Will the new jobs be located at more than one site? Yes ___ No ___
(If Yes, please list which locations)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
PART II – Organizational Leadership Structure
Attach List of Board of Directors/Key Officers of Company
PART III – Financial Information
Attach last three year’s financial statements. If you have been in business less than three years, please attach your business plan.
PART IV – Product or Service Information
Please describe the product or service your company provides or attach a brief history of the company. Include milestones and
accomplishments that have occurred since its inception. Include a brochure or marketing piece from your company if one is
available.
______________
______________
______________
PART V – New Job Creation Projected
Today’s Date __________________________
The information in this section will be used to establish the financial projection for this program. You may breakdown the positions
into line items (allowing for the most accurate projection) or give us one projection for all positions and an average hourly rate.
Number of new jobs ____________@ Hourly Rate or Salary______________ Position Title___________________________
Number of new jobs ____________@ Hourly Rate or Salary______________ Position Title___________________________
Number of new jobs ____________@ Hourly Rate or Salary______________ Position Title___________________________
Number of new jobs ____________@ Hourly Rate or Salary______________ Position Title___________________________
Number of new jobs ____________@ Hourly Rate or Salary______________ Position Title___________________________
Number of new jobs ____________@ Hourly Rate or Salary______________ Position Title___________________________
Number of new jobs ____________@ Hourly Rate or Salary______________ Position Title___________________________
Number of new jobs ____________@ Hourly Rate or Salary______________ Position Title___________________________
Start Hiring Date ________________
End Hiring Date ________________
PART VI – New Building or Addition Anticipated_(if applicable)
The availability of incremental property taxes generated from new construction, at the project site where the new jobs are located,
to fund this project, is dependent on approval of the city or county. If you complete this section please enclose a legal description of
the project site.
Estimated Assessed Value of New Construction ______________
Estimated Date Construction to Start__________
Estimated Date Construction Complete________
Please return to:
Stephanie Bredman
Kirkwood Community College
7725 Kirkwood Blvd SW
PO Box 2068
Cedar Rapids, IA 52406
Phone 319-398-5580
stephanie.bredman@kirkwood.edu
j:\shared\njtc\information for companies\260e application.doc
Tyler McCarville
Kirkwood Community College
7725 Kirkwood Blvd SW
PO Box 2068
Cedar Rapids, IA 52406
Phone 319-398-7782
tyler.mccarville@kirkwood.edu
Rev. 5.0/February 2014