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| * Please enter your information in the fields provided below. |
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| Contact Information: |
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| Company Name: |
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| Name: |
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| Email Address: |
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| Work Phone: |
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| Fax Number: |
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| Address: |
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| City, State, Zip: |
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| Website Address: |
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| Company Information: |
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| Industry: |
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| Business Description: |
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| No. of full-time employees: |
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| No. of part-time employees: |
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| No. of employees expected in 12 months: |
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| Years in business: |
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| How is your HR function currently handled? (In-house HR, Other in-house, PEO, Outsourced, No current system) |
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| Level of Service Interested In: |
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| Administrative Outsourcing |
| Human Resources Consulting |
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| HR Administration: |
| * Please check the services for which you are interested in receiving a proposal. |
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| All |
| Payroll Management |
| Employee Benefits |
| HR Information System |
| Workers Compensation |
| Employee Relations |
| Regulatory Compliance |
| Employee File Record Keeping |
| Pre-Employment Screening |
| Other, please explain: |
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| HR Consulting: |
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| Policy Design |
| Benefit Plan Design |
| Employee Orientation Design |
| Compensation Program Design |
| Recruiting, Staffing, and Selection |
| Strategic Planning |
| Training and Organizational Development |
| Other, please explain: |
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