Superior Skilled Trades - Job Intake Form "*" indicates required fields Sales Person*Choose Your NameBrett ForrestDusty NormanKathy LeeLee GladneyMike SelvaggiMindy HaleMitzi TorresMonica ValenciaRaymond SupRon SchneiderScott FennellSeth SandlerType of Client* New Client Existing Client Type of Project* New Project Existing Project Client Name* Project Name* Brief Project Description Job Site - Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job Site - Please describe the work environment Ex. Inside, Outside, Hot, Cold, Dusty, etc.Job Site - Contact How many unique positions types?*Zero (0)One (1)Two (2)Three (3)Ex. "Welders" would be One (1) unique position type even if you needed to fill 10 spots. Position #1Position Description (ie. Licensed Plumber)* Number of workers needed for this position?What type of job is this? Contract Labor Temp-to-Hire Labor Direct Hire Prevailing Wage Price was quoted:* Based on Markup Based on Bill Rate Please discuss this with Mike Selvaggi if you have questions about how to answer this field.Bill Rate (range if necessary) OT Rate (ex. standard is 1.5x) Markup Rate Pay Rate (range if necessary) Pay (Prevailing Wage) Fringe Rate (Prevailing Wage) Direct Hire - Salary or Hourly Pay Rate Direct Hire - Fee Percentage Start Date Month Day Year Direct Hire - Typical Weekly Schedule (ie. M-F 8-5p) Total Weekly Hours Duration of Project Shift Start Time Hours : Minutes AM PM AM/PM Shift End Time Hours : Minutes AM PM AM/PM Direct Hire - What is the primary location of this position? Direct Hire - Is there travel involved with this position? If so, what percentage? Per diem included? Yes No How much is the per diem? How many days is the per diem? PPE / Tools Required? Yes No Please list the PPE / Tools that are required...Specific Certifications / State Licenses Required? Yes No Please list the certifications / state licenses required...Provide specific skills and experience required by client...Drug Screen Required? Yes No Please specify type of drug test required: DT 5 Panel - DT xCup 5 panel (Amphetamines, Cannabinoids, Cocaine, Opiates, Phencyclidine) PRICE = $26.00 DT 9 Panel - DT xCup 9 panel (Amphetamines, Cannabinoids, Cocaine, Opiates, Phencyclidine, Barbiturates, Benzodiazepines, Propoxyphene, Methadone) PRICE = $29.00 DT 10 Panel - DT xCup 10 panel (Amphetamines, Cannabinoids, Cocaine, Opiates, Phencyclidine, Barbiturates, Benzodiazepines, Propoxyphene, Methadone, Oxycontin) PRICE = $29.00 Other Background Check Required? Yes No Please specify type of background check required: Package # 1 - Basic + 1 Criminal Package ($10) Package # 2 - Standard Criminal Package ($14) Package # 3 - Standard + OFAC, Employment ($30) Quick Check Package ($7) Quick Check Package + Drug Testing Package ($7) Basic 7 Year ($7) Amazon Background ($7) SpaceX Background ($25) Other Click here to see background check package details.Direct Hire - What company benefits are offered for this position?Direct Hire - Is relocation assistance offered (for right candidate)? Yes No Direct Hire - Please provide details for relocation assistance... Provide a detailed description of daily job activities that our employee will perform. What are the physical requirements of the job, including lifting requirements, and other elements? Ex. Bending, Standing, Climbing, Kneeling, TwistingSpecial Requests / CommentsPosition #2Position Description (ie. Licensed Plumber)* Number of workers needed for this position?What type of job is this? Contract Labor Temp-to-Hire Labor Direct Hire Prevailing Wage Price was quoted:* Based on Markup Based on Bill Rate Bill Rate (range if necessary) OT Rate (ex. standard is 1.5x) Markup Rate Pay Rate (range if necessary) Pay (Prevailing Wage) Fringe Rate (Prevailing Wage) Direct Hire - Salary or Hourly Pay Rate Direct Hire - Fee Percentage Start Date Month Day Year Direct Hire - Typical Weekly Schedule (ie. M-F 8-5p) Total Weekly Hours Duration of Project Shift Start Time Hours : Minutes AM PM AM/PM Shift End Time Hours : Minutes AM PM AM/PM Direct Hire - What is the primary location of this position? Direct Hire - Is there travel involved with this position? If so, what percentage? Per diem included? Yes No How much is the per diem? How many days is the per diem? PPE / Tools Required? Yes No Please list the PPE / Tools that are required...Specific Certifications / State Licenses Required? Yes No Please list the certifications / state licenses required...Provide specific skills and experience required by client...Drug Screen Required? Yes No Please specify type of drug test required: DT 5 Panel - DT xCup 5 panel (Amphetamines, Cannabinoids, Cocaine, Opiates, Phencyclidine) PRICE = $26.00 DT 9 Panel - DT xCup 9 panel (Amphetamines, Cannabinoids, Cocaine, Opiates, Phencyclidine, Barbiturates, Benzodiazepines, Propoxyphene, Methadone) PRICE = $29.00 DT 10 Panel - DT xCup 10 panel (Amphetamines, Cannabinoids, Cocaine, Opiates, Phencyclidine, Barbiturates, Benzodiazepines, Propoxyphene, Methadone, Oxycontin) PRICE = $29.00 Other Background Check Required? Yes No Please specify type of background check required: Package # 1 - Basic + 1 Criminal Package ($10) Package # 2 - Standard Criminal Package ($14) Package # 3 - Standard + OFAC, Employment ($30) Quick Check Package ($7) Quick Check Package + Drug Testing Package ($7) Basic 7 Year ($7) Amazon Background ($7) SpaceX Background ($25) Other Direct Hire - What company benefits are offered for this position?Direct Hire - Is relocation assistance offered (for right candidate)? Yes No Direct Hire - Please provide details for relocation assistance... Provide a detailed description of daily job activities that our employee will perform. What are the physical requirements of the job, including lifting requirements, and other elements? Ex. Bending, Standing, Climbing, Kneeling, TwistingSpecial Requests / CommentsPosition #3Position Description (ie. Licensed Plumber)* Number of workers needed for this position?What type of job is this? Contract Labor Temp-to-Hire Labor Direct Hire Prevailing Wage Price was quoted:* Based on Markup Based on Bill Rate Bill Rate (range if necessary) OT Rate (ex. standard is 1.5x) Markup Rate Pay Rate (range if necessary) Pay (Prevailing Wage) Fringe Rate (Prevailing Wage) Direct Hire - Salary or Hourly Pay Rate Direct Hire - Fee Percentage Start Date Month Day Year Direct Hire - Typical Weekly Schedule (ie. M-F 8-5p) Total Weekly Hours Duration of Project Shift Start Time Hours : Minutes AM PM AM/PM Shift End Time Hours : Minutes AM PM AM/PM Direct Hire - What is the primary location of this position? Direct Hire - Is there travel involved with this position? If so, what percentage? Per diem included? Yes No How much is the per diem? How many days is the per diem? PPE / Tools Required? Yes No Please list the PPE / Tools that are required...Specific Certifications / State Licenses Required? Yes No Please list the certifications / state licenses required...Provide specific skills and experience required by client...Drug Screen Required? Yes No Please specify type of drug test required: DT 5 Panel - DT xCup 5 panel (Amphetamines, Cannabinoids, Cocaine, Opiates, Phencyclidine) PRICE = $26.00 DT 9 Panel - DT xCup 9 panel (Amphetamines, Cannabinoids, Cocaine, Opiates, Phencyclidine, Barbiturates, Benzodiazepines, Propoxyphene, Methadone) PRICE = $29.00 DT 10 Panel - DT xCup 10 panel (Amphetamines, Cannabinoids, Cocaine, Opiates, Phencyclidine, Barbiturates, Benzodiazepines, Propoxyphene, Methadone, Oxycontin) PRICE = $29.00 Other Background Check Required? Yes No Please specify type of background check required: Package # 1 - Basic + 1 Criminal Package ($10) Package # 2 - Standard Criminal Package ($14) Package # 3 - Standard + OFAC, Employment ($30) Quick Check Package ($7) Quick Check Package + Drug Testing Package ($7) Basic 7 Year ($7) Amazon Background ($7) SpaceX Background ($25) Other Direct Hire - What company benefits are offered for this position?Direct Hire - Is relocation assistance offered (for right candidate)? Yes No Direct Hire - Please provide details for relocation assistance... Provide a detailed description of daily job activities that our employee will perform. What are the physical requirements of the job, including lifting requirements, and other elements? Ex. Bending, Standing, Climbing, Kneeling, TwistingSpecial Requests / Comments(Optional) Job Description UploadAccepted file types: pdf, docx, Max. file size: 32 MB.Please only use this upload function if your job description will not copy and paste into the fields above.NameThis field is for validation purposes and should be left unchanged. Δ