Request for Proposal

CONFIDENTIAL
For Execustaff HR Internal Use Only

Requestor:    Request Date:    Need By:

Company: 
Contact/Title:
Phone:
Email:
Address:
Industry:
Company Description:
Current Total # of employees:          Full-Time:         Part-Time:
Projected Total in 12 Months:          Full-Time:         Part-Time:
Type of Company:


Website:
How Long in Business:
Previous Startup Experience:
Funded By:




Number of workers' compensation claims in the past 2 years?
Number of employee lawsuits filed in the past year?  
Accounting Firm:
Attorney Firm:
Bank:
Current PEO?
Referral Source:

BENEFITS

Health Benefits Yes No
  Currently providing medical benefits?
  Currently providing dental benefits?
  Currently providing vision care?
  Currently providing LTD?
  Currently providing Life Insurance?
  Spouses/dependents covered on medical benefits (choose one of the following):
   Employee benefits paid 100% - Dependent benefits paid 0%
   Employee benefits paid 100% - Dependent benefits paid 25%
   Employee benefits paid 100% - Dependent benefits paid 50%
   Employee benefits paid 100% - Dependent benefits paid 100%
125 Cafeteria Plan Yes No
  Currently implementing 125 plan?
      Medical premium only?
      Full medical and dependent care?
Retirement/Investment Plan Yes No
  Retirement/investment plan offered?

PAYROLL

What is your pay cycle?
 (choose one)		 Semi-monthly
Weekly
Bi-Weekly
Dates:
Does company currently utilize direct deposit?     Yes       No
Estimate number of hours spent on HR/Payroll tasks per month by whom
    

Prospect Needs:


Proposed Start Date: 

PLEASE PROVIDE A COPY OF THE FOLLOWING: COMPANY CENSUS: Employee Name/Title and Salary, CURRENT WORKERS’ COMPENSATION REPORT INCLUDING RATES (if other than 8810 or 8859), and CURRENT HEALTH BENEFIT PREMIUM STATEMENT.

  


 

  
 
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