Name
First Name
Last Name
E-mail
Client Company Name
Referred By
Referred to WMS
Is this a Confidential Search?
Yes
No
Why?
Name of Position to be filled
Newly created position?
Yes
No
Who handled these duties heretofore?
Title
and/or Consultants
Incumbent's name being replaced (WMS Use Only):
Why?
Incumbent has been with the Company since
Year
If applicable, last day with Company
Position reports to (Hiring Manager)
Title
Name
Hiring Manager has been with the Company since
Year
This Position (To Be Filled) Supervises
# of Direct Reports
Titles of Direct Reports only
# of Indirect Reports
Titles of Indirect Reports only
Position Type
Contract
Permanent
Rate
$/Hour
Term
Weeks
Beginning on or about
Is Position based at US HQ?
Yes
No
If No, is this a Work-From-Home Position?
Yes
No
If a Work-From-Home Position, what equipment will the Company provide?
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Planned office move within one year?
Yes
No
Within how many miles from current location?
Annual Revenue
US %/Intl %
Peak
Peak Year
3 Year Projection
# of Employees
Total #
In HQ
#
In Mgt.
#
In Fin/ACCTG
# in HQ
Plants
#
External Auditors
Tax Advisors
Back Office Service Providers
e.g. ADP, Accounting Services Firms
Private Equity/Venture Capital Firm(s)
ERP System(s) or Accounting & Reporting System(s)
Largest Suppliers
Largest Customers
Largest Competitors
Any Hands-Off (No-Raid) Companies: are there any suppliers, customers or competitors who would be upset with you hiring their employee or that would violate any contract with you, your company or any related company?
Yes
No
Who?
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COMPENSATION & BENEFITS
Annual Base Salary
Salary Range - Ex: $85,000 to $95,000 (Negotiable) Commensurate with Qualifications.
Bonus Awards
Bonus Target
Bonus (Historically)
Bonus
Paid Annually
Stock Purchase Plan
Details, if any
Restricted Stock Plan
Details, if any
Deferred Compensation Plan
Details, if any
401(k) Plan Matched
Up to
Edit the following information accordingly (Click Arrow)
Note: Please edit the below accordingly: - EQUITY PARTICIPATION (If any): Incentive Stock options on Hire Date and annual awards thereafter, subject to the customary BOD approval, commensurate with other Management. - Company subsidized Dental, Vision, Life Insurance, Disability - At least two (2) weeks of Company-paid vacation initially in addition to customary US Holidays - Reimbursement of all necessary and approved CPA Et Al and CPE expenses - Business Casual/Appropriate Dress M-TH; JEANS on Friday - Free Covered Parking OR Fully Subsidized Transit
Relocation Package Details (If any)
Company Subsidized PPO
% for Employee
Company subsidized PPO
% for Dependents
Company subsidized PPO
Ability to Travel
% to %
Domestic
%
International
%
No travel required
Any other Perks/Benefits that would attract the best Candidates
Submit
Should be Empty: