Company Information:
Firm Name:
Contact Name:
Address:
City:
State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
ZIP Code:
Email Address:
Telephone:
Facsimile:
Products or Services:
Size of Company:	Local National	Regional International
Other Offices:	Yes No
If yes, how many offices?
Number of Employees?
Have you ever utilitized a search firm for your employment needs? Yes No
If yes, how many assignments per year?
How would you rate your current search firm (on a scale of 1-5 with 5 being the highest):
Staffing Requirements Information:
Which departments do you anticipate further staffing needs: Administration Sales/Marketing Administration Engineering New Media/High Tech Other:
Hiring: Centralized Departmentalized:
What are your immediate staffing needs: What specific experience should a potential candidate have: What would be most important to you in the evaulation and hiring of new employees:
Candidate Educational Background Information:
Education: Degree required Degree preferred List any other certifications, professional designations or awards needed: What is your job function: