Connecticut Innovations, Inc.
Fiscal Year Ending June 30, 2020

Employment Information Request Form

  • Section I

  • Section II

    (full time = over 35 hours/week; part time = less than 35 hours/week)
  • Section III

  • NAICS (North American Industry Classification System) This is a six-digit number to classify businesses by type of activities in which they are engaged.
  • Date Format: MM slash DD slash YYYY
  • To better understand the companies we work with and to further our goal of diversity in our business endeavors, we are also requesting the following information about company owners. This question is optional.
  • Section IV

  • Date Format: MM slash DD slash YYYY
  • Contact Stepheni Harpin @ or 860-258-7880 with questions.