Employment Information Sheet

 

Company Name:  ____________________________________________________________________________________

Name of Contact Person/Title:  _________________________________________________________________________

Address: __________________________________________________________________________________________

City:  ________________________________________            State:  _______________            Zip:  __________________

Phone: ________________________________________       Fax:  ___________________________________________

E-Mail:  __________________________________________      Website: _______________________________________

 

Description of Position:  ______________________________________________________________________________

 ___________________________________________________________________________________________________

 ___________________________________________________________________________________________________

 ___________________________________________________________________________________________________

 

Years of Experience:  ____________________      Territory Open:  ______________________________________

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Fee Structure

 Members:                                                                            Non-Members:

1-month posting = $35                                                       1-month posting = $40

2-month posting = $55 ($27.50 each)                               2-month posting = $60

3-month posting = $65 ($21.67 each)                               3-month posting = $70