Fillable MONROE MANUFACTURES JOBS PROGRAM APPLICATION I. COMPANY DATA (monroe county)

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MONROE MANUFACTURES JOBS PROGRAM APPLICATION I. COMPANY DATA (monroe county)

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I. COMPANY DATA
Company Name:
Company Contact: Title:
Company Address (non-residence):
City: State: Zip:
Phone: Fax:
E Mail Address: Website:
NAICS Code:
Number of full-time equivalent employees in Monroe County:_________ As of date:
II. COMPANY CERTIFICATION
The company certifies the employee information listed below is true and correct and that the employee
will work at least 35 hours per week.
Employee Hired:
Employee Title:
Date of Hire:
Signature & Title:
III. EMPLOYEE CERTIFICATION
The employee certifies that this is their first job since completing a twenty (20) week, 360 hour job
readiness certificate program at the Rochester Arc and Flame Center. The employee further
certifies that all other information contained below is true and correct.
Employee Name:
Employee Mailing Address:
Employee Phone Number: Social Security Number:
Employee Signature:
IV. ROCHESTER ARC AND FLAME CENTER
I certify that the above noted employee has completed the twenty (20) week, 360 hour job readiness
certificate program class at the Rochester Arc and Flame Center.
Date of completion:
______________________________, Executive Director,
Signature Print Name
Rochester Arc and Flame Center.
MONROE MANUFACTURES JOBS PROGRAM APPLICATION
Monroe County Economic Development
50 West Main Street, Suite 8100
Rochester, New York 14614-1218
(585) 753-2000 Fax (585) 753-2002
monroecounty.gov
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The Monroe Manufactures Jobs program is only available to manufacturers as determined
by Monroe County. Payments from the program will be made upon providing evidence that
the employee hired has been employed for at least one year from the date of hire.
III. COMPANY CERTIFICATION
The undersigned officer of the Company hereby certifies, on behalf of the Company, as follows:
A. The information contained in this application is true and correct. The Company is aware that
any material misrepresentation made in this application constitutes an act of fraud, resulting in
termination of participation in the Monroe Manufactures Jobs program.
B. The Company agrees to retain the full-time employee for a minimum of one year from the date
of hire on application. The company agrees to complete a survey at the end of the first year.
C. The Company will maintain its headquarters at a nonresidential address in Monroe County.
D. The undersigned on behalf of the Company certifies that the Company and its officers (owning
more than 20% of the Company) are current on all real property, federal, state, sales, income and
withholding taxes.
E. Company understands qualification for participation in the program is to be determined by
Monroe County in its sole discretion.
IN WITNESS WHEREOF, the undersigned has executed this company’s certificate as of this date:
Date:
Company’s Name:
Signature:
Print Name & Title:
Rochester Arc and Flame Center to remit completed original form to:
Monroe County Planning & Economic Development
50 West Main Street,
Suite 8100
Rochester, New York 14614-1218
Phone: (585) 753-2000
MONROE MANUFACTURES JOBS PROGRAM APPLICATION
Monroe County Economic Development
50 West Main Street, Suite 8100
Rochester, New York 14614-1218
(585) 753-2000 Fax (585) 753-2002
monroecounty.gov
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MONROE MANUFACTURES JOBS PROGRAM APPLICATION I. COMPANY DATA (monroe county)

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Completed 22 January 2021

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