Connecticut Innovations, Inc.
Fiscal Year Ending June 30, 2025

Employment Information Request Form 2025

• Company Background

• Name of Company*
• Contact Name*
• Contact Title
• Company Address
  Company Mailing Address Company Mailing Address (Line 2) City State / Province / Region Zip/Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country
• Phone
• Email

• Employee Information

  (Full time = more than 35 hours/week; Part time = less than 35 hours/week)
• Total employees as of 6/30/2025 (Full Time)*
  Total full-time employees (including full-time paid interns) as of 6/30/2025
• Total employees as of 6/30/2025 (Part Time)*
  Total part-time employees (including part-time paid interns) as of 6/30/2025
• Total employees in Connecticut as of 6/30/2025 (Full Time)*
• Total employees in Connecticut as of 6/30/2025 (Part Time)*
• Total employees in Connecticut as of 6/30/2025 (Consultants)*
• Average wage per employee (Full Time)*
  All full-time employees (including full-time interns).
• Average wage per employee (Part Time)*
  All part-time employees (including part-time interns).
• Average wage per employee (Consultants)*
• Average wage for new hires in Connecticut as of 6/30/2025 (Full Time)*
• Average wage for new hires in Connecticut as of 6/30/2025 (Part Time)*
• Average wage for new hires in Connecticut as of 6/30/2025 (Consultants)*
• CI validates job numbers by obtaining the following independent reports. Please upload one of the following: 1. Connecticut Department of Revenue Services (DRS) form UC5A or UC5A Worksheet as of June 30, 2025. 2. DRS form UC2 or UC2 Worksheet as of June 30, 2025. 3. Submission from your company’s payroll service showing or listing jobs as of June 30, 2025. 4. Any other suitable form that is submitted to the DRS that shows jobs as of June 30, 2025. 5. Any form submitted to the Connecticut State Department of Labor that shows jobs as of June 30, 2025.*
  Drop files here or Select files

  Max. file size: 50 MB.

• Additional Company Information

• NAICS Code
  NAICS (North American Industry Classification System): This is a six-digit number to classify businesses by type of activities in which they are engaged.
• Gross revenue ($) for latest year ended*
• Date fiscal year ended*
  MM slash DD slash YYYY
• Minority-owned
  • Yes
  • No
• Veteran-owned
  • Yes
  • No
• Women-owned
  • Yes
  • No
• Disabled-owned
  • Yes
  • No
• Name of Preparer*
  Name Title
• Date*
  MM slash DD slash YYYY
• Contact Elizabeth Skrabl with questions (Elizabeth.Skrabl@ctinnovations.com).
• CAPTCHA

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