To be completed by client

    Requested By

    Your Name *
    Your Email *
    Your Phone Number *
    Additional Confirmation Email 1
    Additional Confirmation Email 2

    Note: An email acknowledging receipt of your request will be sent to you, the Employee Supervisor specified below, and the Additional Confirmation Emails specified above.

    Client Company Information

    Client Company Division
    Hourly Pay Rate
    Start Date
    Work State
    Will the employee have internet access
    Yes
    Department Number
    PO#
    Employee Supervisor
    Supervisor Email *
    Supervisor Phone Number
    Description of Job Duties

    New Hire Information

    First Name *
    Last Name *
    Middle Initial
    Home Telephone *
    Cell Phone
    Hire Email

    Background Check

    Drug Test
    Yes
    Criminal Background Check
    Yes
    DMV
    Yes
    Additional Request
    (Please Specify)