New Client Intake Form:
Client Contact Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Job Title
Company Information
Company Name
*
Company Website Link
*
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Industry
*
Managed Service Provider (MSP)
Technology Company (Non-MSP)
Behavioral & Mental Health Services (Therapy & Psychology)
Other
Company Size (Total number of employees)
What are your top 3 core company values?
Company Benefits Package (Please include total benefits including health insurance information, 401k, certification reimbursement, PTO, Maternity/Paternity leave, etc.)
Position Looking to Fill Information
Job Title
*
Base Salary Range
Salary Type (Select all that apply)
Hourly
Salaried (not hourly)
Commission
Bonus Opportunities
Job Description
Please provide a brief description of the role you are looking to fill, including key responsibilities and objectives.
*
Job Description (If Available)
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Qualifications and Requirements
Years of Experience Required
Professional Certifications Required (If Any)
Education Requirements
*
Associate Degree (AS/AA)
Bachelor’s Degree (BA/BS)
Master’s Degree (MA/MS/MBA)
Doctorate Degree (PhD/EdD)
Juris Doctor (JD)
Medical Degree (MD/DO)
Degree is Preferred but Not Required
Degree is Not Preferred OR Required
Other
Technical Skills/Software Proficiency
Please specify if the skill is preferred or required.
Job Location and Work Arrangement
Location this person must commute to (if different from company address):
(Street, City, State, Zip)
Is this position in office, hybrid, or remote?
*
5 days In Office
Hybrid In-Office and Remote Set Up
Full Remote
I Am Not Sure Yet or Open
Work Hours
*
Full-time
Part-time
Target Candidate Profile
Provide at least 3 candidate characteristics (Soft Skills) that are most important for this position (Examples: Communication, Client-Facing, Independent, Creative, Calm Under Pressure, Self-Motivated, Team Oriented, etc).
Describe Your Perfect Candidate in a Few Words:
Trajectory of the Role (What are the growth opportunities for this individual?)
Recruitment Timeline
Desired Start Date
-
Month
-
Day
Year
Date
Additional Information
Include any additional information, such as special requirements, challenges you have faced in your search, or other relevant details.
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