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:___________________

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