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Job Intake Form
Ray Sup
2021-03-17T16:53:23-04:00
Job Intake Form
Sales Person
*
Choose Your Name
Aaron Mason
Brett Forrest
Eric Phillips
Dawn Evans
Kenny Douglas
Mike Selvaggi
Ray Paz
Roberto Irizarry
Ron Schneider
Client Name
*
Project Name
*
Brief Project Description
Job Site - Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
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 #1
Position Description (ie. Licensed Plumber)
*
Number of workers needed for this position?
Bill Rate
*
Margin Percentage
*
Start Date
Month
Day
Year
Total Weekly Hours
Duration of Project
Shift Start Time
:
HH
MM
AM
PM
Shift End Time
:
HH
MM
AM
PM
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
Background Check Required?
Yes
No
Please specify type of background check required:
Package # 1 - 7yr address history SSN search, NCIB + 1 recommendation, IQR 1 & 2 PRICE = $9.00
Package # 2 - 7yr address history SSN search, NCIB + recommendations, IQR 1 & 2 PRICE = $13.00
Package # 3 - 7yr address history SSN search, NCIB + recommendations, IQR 1 & 2, Employment History, OFAC PRICE = $28.00
Special Requests / Comments
Position #2
Position Description (ie. Licensed Plumber)
*
Please fill out a separate form for each unique position.
Number of workers needed for this position?
Bill Rate
*
Margin Percentage
*
Start Date
Month
Day
Year
Total Weekly Hours
Duration of Project
Shift Start Time
:
HH
MM
AM
PM
Shift End Time
:
HH
MM
AM
PM
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
Background Check Required?
Yes
No
Please specify type of background check required:
Package # 1 - 7yr address history SSN search, NCIB + 1 recommendation, IQR 1 & 2 PRICE = $9.00
Package # 2 - 7yr address history SSN search, NCIB + recommendations, IQR 1 & 2 PRICE = $13.00
Package # 3 - 7yr address history SSN search, NCIB + recommendations, IQR 1 & 2, Employment History, OFAC PRICE = $28.00
Special Requests / Comments
Position #3
Position Description (ie. Licensed Plumber)
*
Please fill out a separate form for each unique position.
Number of workers needed for this position?
Bill Rate
*
Margin Percentage
*
Start Date
Month
Day
Year
Total Weekly Hours
Duration of Project
Shift Start Time
:
HH
MM
AM
PM
Shift End Time
:
HH
MM
AM
PM
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
Background Check Required?
Yes
No
Please specify type of background check required:
Package # 1 - 7yr address history SSN search, NCIB + 1 recommendation, IQR 1 & 2 PRICE = $9.00
Package # 2 - 7yr address history SSN search, NCIB + recommendations, IQR 1 & 2 PRICE = $13.00
Package # 3 - 7yr address history SSN search, NCIB + recommendations, IQR 1 & 2, Employment History, OFAC PRICE = $28.00
Special Requests / Comments
Name
This field is for validation purposes and should be left unchanged.
