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JOB CREATION FORM - PERMANENT JOBS TO BE CREATED <br />POSITION TITLE <br />(list permanent full time positions only)* <br />NUOMBER <br />POSITIONS <br />HOURLY CASH <br />WAGE RATE <br />WITHOUT <br />BENEFITS <br />HOURLY VALUE <br />OF BENEFITS ** <br />TOTAL HOURLY <br />CASH WAGE <br />INCLUDING <br />BENEFITS <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />Total jobs to be Created: Average hourly Cash Wage: Average hourly benefits: <br />*For the purposes of the Job Creation Fund program, job creation awards are provided for permanent full-time <br />positions working 2080 hours per year. <br />** includes non -mandated benefits to the employee. Social security tax, unemployment insurance, workers <br />compensation insurance and other benefits mandated by law must be excluded. <br />NOTE: Minnesota job creation fund businesses must pay each new full-time employee added pursuant to the <br />agreement total compensation, including benefits not mandated by law, that on an annualized basis is equal to at <br />least 110 percent of the federal poverty level for a family of four. <br />5 <br />102214 <br />