Form Sfn 59686 - Business Incentive Agreement - North Dakota Department Of Commerce Page 2
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4SFN 59686 (04/2012)
Page 2
Public Purpose (check only one)
Assisting community development
Increasing tax base
Directly creating employment opportunities
Indirectly creating employment opportunities through increased economic activity
Job Retention (only in cases where job loss is specific and demonstrable)
Current Employment, Wages, Benefits and Compensation
Current Number of jobs (FTE’s):
FTE Definition:
For our reporting purposes, full time equivalent employees work 32 hours per week or
greater. The exception is when a single position is filled by two people. In this instance
each person needs to work 20 hours per week or greater to be considered an FTE.
Please round total job numbers to the nearest half FTE (0.5 FTE).
Average Hourly Wage
Value of Average Benefits Per hour
Average Hourly Compensation (Wages
plus benefits)
Explain
Seasonal
* If this is a new business, check here and please enter 0 for jobs, wages, benefits and compensation. If this is an existing business
with employees, please enter information that reflects your current status with regard to jobs, wages, benefits and compensation.
Annual Job Verification Contact
Name
Email
Phone
Goal Information
In exchange for the incentive provided by the GRANTOR, the RECIPIENT
in
agrees to, within 2 years, (check only one)
Create Jobs
Retain Jobs
Neither create nor retain jobs**
(Location)
Number of jobs (FTE’s) to be created or
FTE Definition:
retained:
For our reporting purposes, full time equivalent employees work 32 hours per week or
greater. The exception is when a single position is filled by two people. In this instance
each person needs to work 20 hours per week or greater to be considered an FTE.
Please round total job numbers to the nearest half FTE (0.5 FTE).
Average Hourly Wage
Value of Average Benefits Per hour
Average Hourly Compensation (Wages
plus benefits)
**If ‘neither’ is check marked, please enter 0 for number of jobs, wages, etc. Even RECIPIENTS with no job goals must file recipient
reports as described on page 3 of this document. Any increase in jobs, wages, benefits or total compensation will be reported as a
bonus above and beyond project goals.
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