Contact Information

Salutation: Mr. Ms.

First Name:

Last Name:

Title:

Company Name:

Address 1:

Address 2:

City:

State / Province:

Zip / Postal Code:

Country:

Website URL:

Email Address:

Telephone Numbers:

Firm:

Mobile:

Other:

Fax:

Your Recruiting Firm

Select the choice that best describes your firm:
Firm Type: Independently owned Recruiting Firm with no franchise affiliation

Independently owned Recruiting Firm with franchise affiliation

Consulting Firm - IT, Engineering, other

Subsidiary/Division of a privately-held company

Subsidiary/Division of a publicly-traded company

If other, please describe:

How long has your firm been in business? <1 year 1 to 3 years >3 to 10 years >10 to 15 years >15 years

If you selected < 1 year, when did your firm begin? Month: January February March April May June July August September October November December      Year:

How long have you personally been in the recruiting business?
<1 year 1 to 3 years >3 to 10 years >10 to 15 years >15 years

Are you an owner of your recruiting firm? Yes No

If no, what is your position with your firm? Recruiter Business Development Administrator Other

How many people own your recruiting firm?

How many recruiters including yourself, if applicable, work in your firm?

What is the timing of your interest in applying for membership in NPA?
Within 30 days Next 3 months Within 12 months No timeframe, research only

Does your firm have more than one office location? Yes No

If yes, how many?

If yes, where are the offices located?

Services and Market Coverage of Your Recruiting Firm

Specialty / Niche:

Geographic Market areas serviced:

Direct Placement%:

Contract Placement%:

Contingency Recruitment%:

Retained Search%:

Other %:

Split-Fee Placement History of Your Recruiting Firm

Does your recruiting firm have experience with split-fee placements? Yes No

If yes, how many split placements have you made in the last 12 months?

Import %:

Export %:

Do you have a strategic interest in making split-fee placements?
Yes No

Has your recruiting firm ever been a member of a split-fee placement network?
Yes No

If yes, are you a current member? Yes No

If yes, please state in which network you are a member and for how long.

If no, state which network and explain why you are no longer a member.

Were you ever a member of NPA? Yes No

If yes, in what year did you leave and why?

Why is your firm interested in joining NPA To load job orders/assignments into the database
To search the database for candidates
To load candidates into the database
To search the database for job orders/assignments
To expand our services geographically
To expand our services in our specialty/niche areas
To network with owners of other recruiting firms
Other If Other:

Referred by: Advertisement Article Blog Posting / Social Networking Contact Direct Mail Email Marketing Internet Search NPA Member NPA Member Website/Email NPA Website Other Website - please provide link below Tradeshow Other

If other, please describe:

First Name:

Last Name:

Firm Name:

How well do you know this person: Know very well, have done splits together Know well, attempted splits Know well Have met/spoken, do not know well

Additional Comments: