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Hire DFB Incentive Program
Application Form
Business Name: 6 Digit NAICS Code:
Federal Tax ID #.: City Business License #:
Physical Address:
Contact Person’s Name: Title:
Contact Person’s Email: Phone:
Detailed description of Business Activity:
Reason for adding the new jobs:
Current Number of Employees: Full time: Part-time:
Number of Local Hires (current employees whose home address is
within Zip Codes 33441, 33442 and 33064 within the incorporated city limits of the City
of Deerfield Beach)
Proposed Number of New Local Hires: Salary Range:
Job Title(s) of New Local Hires:
I certify to the hiring of ___________ Deerfield Beach Residents for a period of no less
than six (6) months with starting dates of employment starting within 3 months of
application approval, and with regular employment of 35 or more hours per week on
average.
The information contained herein is true, complete and correct to the best of my
knowledge. I certify that I have authority to apply for this grant on behalf of the business
described herein. I understand that this information may be made available for public
review and is subject to the terms of the Florida Public Records Act.
___________________________________________ _____________________
Signature of Official or Authorized Representative Date
___________________________________________
Printed Name Position
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signature
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