Rogue Valley Rapid Response Employer Request Form

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Prior to, during or after a layoff an employer can request assistance from the Rapid Response team. The sooner the notification the greater the chance that layoffs can be avoided or resources shared with employees. Please answer the questions below and someone from Rapid Response team will be in contact with you. Thank you

Date of incident leading to closure or job loss?

TTTT

Business/worksite address - physical location (NO PO box) - Street

Address Line 2 (if needed)

City/Town

Postal/Zip Code

Name of Business/Employer *

Your Name (First) *

Your Name (Last) *

Your Phone Number *

Your E-mail Address *

Are affected workers Union represented?

Yes

Batalkan pilihan

If workers are Union represented, what is the Union name. Also, provide a contact name with their phone number or e-mail.

Number of affected workers (if unsure provide a range) *

Are affected workers

Full time

Part time

Full and Part time

Batalkan pilihan

Industry type (e.g. manufacturing, construction, food services, healthcare, retail, etc.) *

Please provide a brief description of your situation and current needs:

Kirim

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