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Critical Need Position Profile

Please complete this form. We will then contact you regarding your critical need.

Name:
Title:
Company Name:
Company Address:
Telephone:
E-Mail:
	Will we be working with you throughout the hiring process?  Yes No
	If not, then with whom will we be working?
Name:
Title:
Telephone:
	Should we contact this person immediately?  Yes No
Are shares of your company publicly traded?	Yes No
If yes, enter your ticker symbol:
	Position Information
Position Title:
Position Based In:
Basic Duties and Responsibilities:
Absolute Requirements:
	Compensation
Base Salary Range:
Bonus?	Yes No
If yes, approximately how large?
Stock Options?	Yes No
If yes, approximately how many option shares?
	Have you:
Exhausted your internal/word-of-mouth search?	Yes No
Run advertisements of any kind?	Yes No
Engaged the services of any other search professionals?	Yes No
	Are you prepared to:
Conduct interviews immediately?	Yes No
Interview, hire and establish a start-date within 45 days?	Yes No

Thank you for completing this form. Please review it for accuracy and then click "Submit" below to continue.