Environmental & Construction
Employment Resource Services
102 Browning Lane-Building C- Lower Level Cherry Hill, New Jersey 08003
Phone#: (856) 427-9500 Fax#: (856) 427-9508
Complete the form and mail or fax it to us. Please call with questions.
NEW EMPLOYEE REQUEST FORM
COMPANY INFORMATION
COMPANY NAME: _____________________________________________________________________
COMPANY ADDRESS: __________________________________________________________________
CITY: ____________________________STATE: ____________ZIP
CODE: _______________________
COMPANY PH.#: _______________ COMPANY FAX#:_______________
E-MAIL: ___________________
CELL PHONE: __________________ WEB SITE: _______________________
TYPE OF SERVICES COMPANY PROVIDES:___________________________________________________
TYPE OF INDIVIDUAL(S) NEEDED
POSITION TITLE(S): ___________________________________________
HOW MANY NEEDED?:______
DESCRIPTION OF DUTIES: _____________________________________
DATE NEEDED BY:____________
AMOUNT OF EXPERIENCE REQUIRED: _______________________________YEARS:
____ MONTHS:____
IS SPECIAL EDUCATION REQUIRED? YES ___ NO ___ HIGH
SCHOOL: ____ JUNIOR COLLEGE: ____
GRADUATE SCHOOL: ____ 40-HR. HAZWOPER TRAINED: _____
OTHER TRAINING: _________________
TYPE OF DEGREE MAJOR PREFERRED (IF REQUIRED): ________________________________________
ANY OTHER PERTINENT INFORMATION: ____________________________________________________
EMPLOYMENT SEARCH AND PLACEMENT AGREEMENT
I, ___________________________________, agree to
pay Environmental & Construction Employment
(Print name and title)
Resource Services (ECERS) $295.00
per person, for the search and referral of each individual
they provide to work for my firm: _______________________.
I understand that the payment for each
(Name of your company)
Individual employment candidate accepted by my firm
must be paid in advance, prior to the employment of
any workers presented to my firm by ECERS. I also understand
and agree that after ECERS has provided my firm with
qualified workers, ECERS will not be responsible for
the attendance, performance, conduct, or early departure
from my firm in the event that new employees resign
or are terminated by my company, since the workers
that ECERS provide will be considered as reliable and
responsible adults.
SIGNATURE:_________________________________________________
DATE: ___________________
___________________________________________________________________________
PAYMENT INFORMATION
Cardholder’s Name: _________________________________________________________________
Address: __________________________________________________________________________
City: ________________________________________State:
___________Zip:__________________
Phone: ______________________Ext: _____________
Cardholder’s Signature: ______________________________________________________________
Check One:
VISA___ MASTERCARD____AMEX ____CO. CHECK____
CREDIT CARD NUMBER_____________________________________________________
EXPIRATION DATE:___________________ |