Job Creation Performance Grant Application

ANNUAL APPLICATION — DEADLINE: APRIL 1ST EACH YEAR

Applications are submitted annually for the PRIOR calendar year (January 1 – December 31).

Example: Jobs created in calendar year 2026 must be reported by April 1, 2027.

There is no pre-approval required for this grant. Jobs must be created and maintained before applying.

PROGRAM OVERVIEW

The Job Creation Performance Grant rewards businesses within the Staunton Enterprise Zone for creating net new full-time permanent employment. Grants are performance-based — paid after qualifying positions have been created and verified. Positions must not have previously qualified for other local Enterprise Zone grants.

Grant Component	Amount per Qualifying Position
Base Grant	$500 per net new full-time position
Skills Training Bonus	$250 per position (when documented training occurred)
Retention Bonus	$250 per position maintained for 18+ consecutive months

Qualifying position requirements: Full-time (35+ hours/week) · Net new to the business · Pay at least 300% of federal minimum wage · Health benefits offered · Maintained for at least 11 consecutive months · Not previously applied for under another local EZ grant

One Grant per Position: Each qualifying position may receive a grant award only once. Positions that have previously been submitted and approved under this grant are not eligible for re-application in subsequent years.

SECTION 1 — APPLICANT INFORMATION

Business Name(Required)

Business Street Address / City / State / Zip(Required)

Federal Employer ID (FEIN)(Required)

Virginia Employer Account #(Required)

Primary Contact Name(Required)

Primary Contact Title(Required)

Phone(Required)

Email(Required)

SECTION 2 — GRANT YEAR & EMPLOYMENT SUMMARY

Grant Year (Calendar Year Being Reported)(Required)

Base Employment Count — January 1 of Grant Year(Required)

Total Full-Time Employees — December 31 of Grant Year(Required)

Net New Full Time Positions Created During Grant-Year(Required)

Number of Positions Claiming Base Grant ($500 each)(Required)

Number of Positions Claiming Training Bonus ($250 each)(Required)

Number of Positions Claiming Retention Bonus ($250 each)(Required)

Total Grant Amount Requested ($)(Required)

SECTION 3 — QUALIFYING POSITION DETAIL

List each new qualifying position below. Add a new position row by clicking the + to the right of the last row.

Job Title

Hire Date

Hourly Wage

Benefits? (Y/N)

Grant Components Requested

SECTION 4 — WAGE VERIFICATION

Federal Minimum Wage as of December 31 of Grant Year ($)

300% of Federal Minimum Wage ($)

Do ALL qualifying positions meet or exceed the 300% threshold? (Yes / No)

SECTION 5 — REQUIRED DOCUMENTATION CHECKLIST

Incomplete applications will not be processed.

Virginia Quarterly Wage Reports — all 4 quarters of the grant year

Drop files here or

Max. file size: 2 GB.

W-2 forms or payroll summary for each qualifying position

Drop files here or

Max. file size: 2 GB.

Documentation of health benefits plan offered to qualifying employees

Drop files here or

Max. file size: 2 GB.

Training documentation (for Training Bonus claims) — certificates, vendor invoices, or trainer confirmation

Drop files here or

Max. file size: 2 GB.

18-month payroll records for each position (for Retention Bonus claims)

Drop files here or

Max. file size: 2 GB.

Copy of current Business License

Max. file size: 2 GB.

Certificate of Good Standing (Virginia SCC)

Max. file size: 2 GB.

CERTIFICATION

I certify that the information provided in this application is true, accurate, and complete to the best of my knowledge. I understand that any misrepresentation may result in disqualification from the Job Creation Performance Grant and/or repayment of any funds received. I agree to comply with all program terms and conditions and to provide additional documentation upon request.

Printed Name

Title / Position

Date