Your Name:

Your Title:

Title of position to be filled:

Client/Co. Name:

Address:

City:

State/Province: (must use two-letter code if in US)

Zip/Postal Code:
-

E-Mail Address: (Your E-mail Address)

Day Phone:

Pager:

Mobile Phone:

Home Phone:

800#:

Is there a preferred time of the day to call you?

Company Information and Background

Branches/Size:

Number of employees:

Van Line affiliation?:

Years with Van Line affiliation?

Prior Van Line affiliation?

Company best known as what type of mover?(N/A,COD,Etc.)

Can you send us any company promotional material?:
Yes No

Do you have a written formal job description?
Yes No

Do your employees know that you are looking to fill this position?
Yes No

Why is this job open?

How long has it been open?

Have you advertised for this position?
Yes No

If presently filled, should our search be confidential?
Yes No

Salary Range:

Commission:

Bonus:

Would you consider a signing bonus?
Yes No

Benefits:

Stock?
Yes No

Vacation?
Yes No

Medical/Dental?
Yes No

401K?
Yes No

Auto/Expense/Allowance?
Yes No

Cell Phone provided?
Yes No

Computer provided?
Yes No

Expense Reimbursements
Yes No

Education Level Required

Professional Designations Preferred?

Travel Required?

Minimum industry experience required

Relocation Policy?

Competitors we can't recruit from?

Other openings in your company?

Who have you interviewed

How soon must this position be filled?

Do you have any questions of us?

Are you using any other recruiters now?
Yes No
Have you used a recruiter in the past?
Yes No

Thank you!