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Light Industrial Staffing
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Existing Applicants
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New Employer Application
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New Employer Application
New Employer Application Form
Complete this form to be considered as a potential new employer in our program.
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Company Name
Owner Name
*
First
Last
Company Address
Address 2
City
State
Zip Code
Tax ID
Business Start Date
Legal Status
Affiliated Companies
CPL Number
Contact Name
*
First
Last
Phone Number
Email
*
Billing Name
Billing Address
Billing Address 2
City
State
Zip Code
Bank Name
Account Name
Date Opened
Contact
First
Last
Branch
Branch Address
Address 2
City
State
Zip Code
Line of Credit
Yes
No
Trade Reference 1
First
Last
Phone
Date Opened
Credit Rating
High
Medium
Low
None
Trade Reference 2
First
Last
Phone
Date Opened
Credit Rating
High
Medium
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None
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