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) County: 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
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Company Background Form - Nixa Area Chambernixachamber.com/documents/Company Background Survey.pdfCompany Background Form Company Information Person Filling Out This Form: Date Form
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Company Background Form Company Information Person Filling Out This Form: Date Form Filled Out:
Company Name: Previous Company Name(if applicable):
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