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After you and the company with the contract assignment finalize the bill rate and pay rate, please complete the following information to initiate the employer relationship. Please note: The information provided on this form will be used to generate legal documents including payroll and invoicing reports. Please confirm that all information is correct.

Company with Contract Assignment
Company Name:
Contact Name:
Address:
City, State, Zip:
Phone:
Fax:
Email:
Hourly Bill Rate:

Invoice Contact at Company Information
Invoice Contact Name:
Invoice Contact Address:
Invoice Contact City, State, Zip:
Invoice Contact Phone:
Invoice Contact Fax:
Invoice Contact Email:

Candidate Information (Contractor)
Name:
Street Address:
City, State, Zip:
Phone:
Email:
Job title:
Start date:
End date:
Hourly pay rate:

Please provide a brief job description in the box at right.