Job Placement Form
Recruiter/Staffing Firm
*
First Name
Last Name
Recruiter Email
*
example@example.com
Your Client Name
*
Your Client's Address (Location where Candidate will be working)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Remote Candidate Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Invoices Contact
*
First Name
Last Name
Invoices Contact Email
*
example@example.com
Invoices Contact Phone
*
-
Area Code
Phone Number
Billing Terms:
*
Invoice Notes:
Timecard Approver
*
First Name
Last Name
Timecard Approver Email
*
example@example.com
Timecard Approver Phone
*
-
Area Code
Phone Number
W2 or 1099
*
W2
1099
Exempt from OT
*
YES
NO
Work State
*
Job Title
*
Job Description (only needed if non-clerical 8810 position)
Pay Rate
*
Bill Rate
*
Candidate Name
*
Candidate Social Security Number (Needed to Send On-boarding Paperwork)
*
Candidate Phone Number
*
Candidate Email Address
*
Candidate Start Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: