C. E. Publications, Inc.


Thank you for your interest in advertising with us. Before we can accept your advertising, however, we ask that you fill out this questionnaire to establish your firm's eligibility to advertise with us. Our publications are available only to firms advertising specific types of job openings. Thank you for taking the time to complete this request. - Jerry A. Erickson, Publisher

Your Email Address _____________________________________________

Name of your firm ___________________________________________________________________________ Date ___________________

Industry or Professional Associations to Which Your Firm Belongs __________________________________________________________

Address ____________________________________________________________________________________________________________

City ___________________________________________ State __________ Zip ________________ How Long in Business? __________

Telephone Number (      ) __________________________________ Fax Number (      ) __________________________________

World-Wide-Web Site Address (URL) _________________________________________________________________________________

Your Name _________________________________________________ Position with firm _______________________________________

What type(s) of employees does your firm hire?  O Contract (temporary)  O Direct (captive)  O Both

Please indicate which type(s) of job openings you would like to advertise in our publication(s):

  Contract (temporary) openings  O Direct (captive) openings  O Both

Where would the individuals you recruit from those ads be working?  O In your facility  O In your client's facility  O Both

Who would be supervising the day-to-day work of those recruited?  O Your company  O Your client company

Is there any fee to apply for, or accept, positions you would be advertising?  O Yes*  O No  *If yes, explain ________________


Does your company manufacture or market a product that is marketed to the public or to businesses?  O Yes*  O No  *If yes, explain


Is your firm a division, subsidiary, or in any manner affiliated with a parent company?  O Yes*  O No

*If the answer to the above question is yes, please answer the following questions:

The name of your parent company ____________________________________________________________________________________

Was your firm formed primarily for the purpose of providing contract employees to your parent company?  O Yes  O No

Indicate which of the following your firm shares with your parent company:

  O Office Space  O Telephone  O Fax  O Staff  O Equipment  O Payroll OFacilities  O Nothing

Do you place contract personnel with your parent company?  O Yes  O No

Do you place contract personnel with firms other than your parent company?  O Yes  O No

If so, are those other companies, in any manner, affiliated with your firm or your parent company?  O Yes  O No

Approximately what percentage of the total number of contract personnel that you place work for your parent company? _____%

Does any other contract firm supply contract personnel to your parent company?  O Yes  O No

If so, what are the names of three of those contract firms?

  Firm ________________________________________ Office Location _____________________________________________________

  Firm ________________________________________ Office Location _____________________________________________________

  Firm ________________________________________ Office Location _____________________________________________________

Are contract employees that you place with your parent company treated any differently than those placed by other contract firms?

  O Yes  O No

If your contract employees are treated any differently, please explain the differences: _______________________________________



You must fill out this questionnaire and return it to us with your signature below in order for us to consider acceptance of your advertising. Any literature or information which you can furnish us to verify your answers will be appreciated. Thank you for your cooperation.

I attest to the fact that all answers on this questionnaire are true to the best of my knowledge.

Signature _________________________________________________________________

Printed Name _____________________________________________________________

PLEASE RETURN COMPLETED FORM TO: C.E. Publications P.O. Box 3006 Bothell, WA 98041-3006 Fax 425/806-5585 Rev. 4/96