Client Registry

CLIENT REGISTRY

Decision Maker /Primary Client Full Name *

Company Name *

Company EIN# *

Solicitation # *

Company DUN'S Number *

Company Email Address *

Company Phone Number *

Service Required (Staffing Consultation or Recruitment Consultation) *

Placement Requested *

Labor Staffing Placement
Labor Direct Hire Placement

Signature *

Date *

Why? ( Leave Details) *

Placement Date: *

Are you Requesting a copy of the Placement form *

Yes
No

Business I-9 Submitted (Y/N) *

Yes
No

I-9 Submission Date *