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Employers - Placement Request Company Information - General Company Name Company Representative Name Company Representative Department Phone xxx-xxx-xxxx Ext.     Position Information - General Position Driver   Warehouse   Clerical   Sales   Other If position is "Other", please specify Experience Required Job Description Education Required License Required MVR Insurance Requirements Shift OT -- Select One -- Yes No If "Yes", please provide details:     Compensation Starting Wage Raises Pay Periods Annual Bonus     Benefits Information Benefits Carrier Cost of Benefits When are benefits effective Retirement Plan -- Select One -- Yes No If "Yes", please provide details: Vacation Sick Days Paid Holidays     Union Information (if applicable) Union -- Select One -- Yes No When is Union eligibility effective Union Initiation Fee Union Monthly Dues     Pre-employment Requirements Drug Test -- Select One -- Yes No Physical -- Select One -- Yes No Background Investigation -- Select One -- Yes No Credit -- Select One -- Yes No Additional Testing     Company Background Information Hiring Process Time in Business National/Local/Regional Other Divisions Product     Miscellaneous Uniforms -- Select One -- Yes No Uniforms Cost

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