Client Permanent Workforce Request (EOR Model)
Prosper Workforce Solutions serves as the Employer of Record for assigned personnel and provides payroll, workers’ compensation, HR administration, and compliance verification. This request is for permanent workforce placements under the EOR model.
Company/Organization Name
*
Organization Type
*
Please Select
Home Health Agency
Assisted Living / Group Home
Healthcare Facility
Construction Company
Skilled Trades Employer
Manufacturing / Warehouse
Other
If “Other”, please specify
Primary Contact Name
*
First Name
Last Name
Primary Contact Title
*
Primary Contact Email
*
example@example.com
Primary Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your Billing Contact different than Primary Contact?
*
Yes
No
Billing Contact Name
*
First Name
Last Name
Billing Contact Email
*
example@example.com
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Workforce Request (Roles, Counts, Hours)
Roles Requested
*
RN
LPN
CNA
HHA
General Labor / Helper
Skilled Trades
Supervisor / Lead
Administrative / Office Support
Other
If Skilled Trades, specify trade(s)
If Other, specify role(s)
CNA – Number of Workers Needed
Please Select
1
2
3
4
5
6+
CNA – Minimum Monthly Hours Commitment
Please Select
140 hours/month
160 hours/month
Other (specify)
CNA – If Other, specify monthly hours
HHA – Number of Workers Needed
Please Select
1
2
3
4
5
6+
HHA– Minimum Monthly Hours Commitment
Please Select
140 hours/month
160 hours/month
Other (specify)
HHA– If Other, specify monthly hours
RN – Number of Workers Needed
Please Select
1
2
3
4
5
6+
RN– Minimum Monthly Hours Commitment
Please Select
140 hours/month
160 hours/month
Other (specify)
RN– If Other, specify monthly hours
LPN – Number of Workers Needed
Please Select
1
2
3
4
5
6+
LPN– Minimum Monthly Hours Commitment
Please Select
140 hours/month
160 hours/month
Other (specify)
LPN– If Other, specify monthly hours
Skilled Workers – Number of Workers Needed
Please Select
1
2
3
4
5
6+
Skilled Workers– Minimum Monthly Hours Commitment
Please Select
140 hours/month
160 hours/month
Other (specify)
Skilled Workers– If Other, specify monthly hours
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Schedule & Coverage
Coverage Needed
*
Full-Time Coverage
Day Shift
Evening Shift
Overnight Shift
Weekend Coverage
Rotating Schedule
Expected Start Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Anticipated Length of Assignment
*
Ongoing / Long-Term
6+ Months
12+ Months
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Work Location & Site Notes
Primary Work Location Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Environment / Population Served
*
Seniors
Individuals with Disabilities
Behavioral Health
General Workforce
Construction / Jobsite
Other
Site-Specific Rules / Expectations
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Agreement Acknowledgments + Signature
Authorized Representative
*
Title
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type a question
*
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