business solutions

job order form

Please complete and submit the form below. An EMBERS Staffing Solutions representative will contact you soon to discuss your staffing needs. Thank you.

P.O. # (if applicable)

Company

Order Placed By

Phone

Position(s)

Number of workers required

Site Address (where to dispatch employee to)

Site Contact

Site Contact Phone

Alternate Phone

Start Date (d/m/yr)

Length of job (approx. days/wks/ongoing/etc)

Daily start time

Daily end time

Days of the week

Safety Equipment Requirements

Boots
Hard Hat
Rain Gear
Hammer
Other

Job Description

Notes/Special Requirements/Requests

Do you require a rate agreement?

Yes
No

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