Customer Number:  If you do not have a current customer number please fill in new customer section.

Skip this section if you are an existing customer.

New Customer -- 

Company Name:

Address:

City: State: Zip: 

Telephone Number:

Is this position  TemporaryTemp-to-HireDirect PlacementDepends on Candidate?

    If Temporary, What is the approximate length of assignment  1 DayLess than 7 daysTwo Weeks1 MonthIndefinate?

What type of position  ClericalSecretarialIndustrialTradesTechnicalManagerialITEngineeringProfessional?

Job Duties:

Special Skills or Licenses Needed:

Educational Background Needed:  None RequiredHigh School DiplomaTechncial or Trade SchoolSome CollegeAssociates DegreeBS or BAMastersP.H.D. Major area of Study: 

Hours:

Start Date:

Name of person completing this order: 

Telephone number: 

E-Mail address: 

Thank you for completing this Order/Inquiry.  A Coordinator will be assigned to this order based

their expertise.  Please note that this on-line form will give us just a quick overview of your needs,

and that a more through job order will in all likelihood need to be taken.