Candidate Search Request Form

Please fill out this brief form to request a candidate
and we will get back to you as soon as possible!


Name:
Company Name:
Address:
City:
State:
Zip Code:
Phone:
E-mail:
	above is a home address
	above is work address



Secondary Name:
Company Name:
Secondary Address:
City:
State:
Zip Code:
Secondary Phone:
Secondary E-mail:
	above is a home address
	above is work address
	May we e-mail resumes?



Industry:
Official Title of Position:
City of Your Opening:
State of Your Opening:
Salary comfort range:
Maximum salary:
Incentive range:
Realistic first year incentive:
Degree requirements:
Minimum experience requirements:

Position description:

	Will the person supervise?
How many:
Types of people:
Will report to?
Name
Title
% day of travel:
% of overnight travel:
Day or overnight:
Career path opportunities:

Benefits or special perks:

Considering local candidates only or will you relocate:

What is your relocation policy?
Number of candidates under consideration at this time:
How many other recruiting firms are you working with:
	I am interested in "Exclusive Search"
Question or Comment:

Attach Job Description (.doc):