CONTRACT ASSIGNMENT FORM - HR Search, Inc.
710 N. Main Street Crown Point, IN 46307

Job Title:		# Needed:			Job Order Date:			Job Order Number:
Company Name:			Projected Start Date:				Written By:
Contact:					Title:
Address:		City:			State:			Zip Code:
Direct Phone:		Cell:			Fax:			Email:
Parent Company:
Brief Description of Contact (How long with the company? Previous experiences, etc.):

REASON

How Long Open:

How Many Interviews:

Internal Candidates:

Other Strong Contenders:

Expansion:

Transfer:

Retired:

Promotion:

Termination:

STRENGTHS OF CANDIDATES INTERVIEWED

WEAKNESSES OF CANDIDATES INTERVIEWED

1.	1.
2.	2.
3.	3.
4.	4.
5.	5.
NOTES:

POSITION INFORMATION

Duties and Responsibilities:

MINIMUM SKILLS / MANADATORY SKILLS / EXPERIENCE NEEDED FOR HIRE

1.
2.
3.
4.
5.
Position Reports To / Title:	Number of Individuals in Department:
Education Required:	Degree / Certifications / Licenses, etc:

KNOCK OUT FACTORS  (TOP THREE MUST HAVES IN ORDER OF PRIORITY)

1.

2.

3.

COMMON DENOMINATORS OF SUCCESSFUL HIRES

PERSONALITY TRAITS PREFERRED

1.	1.
2.	2.
3.	3.
4.	4.
5.	5.
Why would someone want to work at your facility:

COMPENSATION

Bill Rate:			Duration of Assignment:				Hours Per Week:
Working Hours:					Flex Time Available / Explain:
Sent H&R Info:			Requested Compnay Information:				Sent Copy of Job Order Leter:
Territory:			Overnight:				% Travel:

AGREEMENT

Fee Percentage if Converted to Direct Hire:					Guarantee:
Interviewing Expenses Paid:					Willing To Relocate / Details:

BENEFITS IF CONVERTED TO DIRECT HIRE

Insurance Carrier:
Check Off	Hosp		HMO		Dental		STD
	MM		PPO		Vision		LTD
	Sick Personal Days		Profit Share		Tuition Reimbursement		Pension Vesting
	Life Ins		401K		Vacation Weeks/Yr		Dependent Coverage Cost
	Individ'l Coverage Cost		Benefits Available After		Company Car/Details		Expenses Covered/Amount

HIRING PROCESS

	#		Time Lapse		Interviewer			Title		Location
PI
F2F
Panel
Offer
Hire
Final Decision Maker:

COMPANY INFORMATION

Years in Business / Since:			# of Employee in Company / Department:				Industry Standing: Public/Private:
Project Growth:			Training Program:				Major Competitors: