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Contact Name:
Job Title :
Company Name:  
Address:

City:

State:
Zip code :
If applicable, please provide cross streets:
Metropolitan Area
Phone:    Extension:
Alternate Phone :    Extension:
Fax:
Email Address:
Best time to reach you:
POSITIONS TO FILL (see list):
Expertise desired
Start Date:    or explain:
Type of Placement
Duration of project (approximate):
Hours per week (approximate):
Would you wish to review resumes? Yes No
Would you wish to interview candidates? Yes No Undecided
Desired hourly range? $ to $ per hour
unspecified, will consider going market rates
Additional Comments
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