Membership Application Form  
 
If you are an active recruiter and have been invited to become a Member by an existing member (your sponsor) we invite you to complete the Membership Application Form below.

ALL FIELDS MUST BE COMPLETED IN ORDER FOR APPlICATION TO BE PROCESSED.
  Sponsors (Members) Name: 
  Applicant's First Name: 
  Last Name: 
  Job Title:
  Company Name:
  Street Address:
  City:
  State:
  Zip Code:
  Email Address:
  Web Site Address:
 Business Phone:
 Fax Phone:
 Toll Free:
 What is your firm's total number of offices including your headquarters office:
 How many recruiters and support personal  /  project managers / researchers) are in your  company?
 Is your company a member of any other  associations and if so which one(s)?
 How many of your staff do wish to have listed on our site and receive our mailings?
 Best Time To Contact You:
 What is your desk Specialty?

  For example: Software: Sales, Sales Support,  Management and Marketing
 Please let us know why you wish to join  US-Recruiters.com. Also, please let us know  what you expect to gain from membership in  us-recruiters.com.

  For the Newsletter: Birth Date - Month and Day:
  For the Newsletter: Wedding Anniversary:
  For the Newsletter: Date & Year you became a recruiter:
  For the Newsletter: Date & Year - Business Anniversary:

  Are you a CPC Certified - Yes or No
  Please provides us the names, telephone numbers and email addresses of two recruiters (non-members) you have recently conducted splits with:

We will be calling your referecnes prior to the final approval as a member of The US Recruiters Network.

  Recruiter Number One: Name & Tele #
  Recruiter Number Two: Name & Tele #
 In the event a financial dispute involving a split with a member, I agree to resolve the dispute by bring my case to the US Recruiters Arbitration Board.
Yes     No
 I agree to promptly pay my Dues upon submitting this form
Yes     No

Electronic Signature (Your Full Name)
Todays Date: