Staffing Request Form Company Name* Contact Name* First Last Company Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone*FaxEmail* Enter Email Confirm Email Personnel work location informationCompany Name* Contact Name* First Last Company Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone*FaxType of personnel & number neededCertified Workers' Compensation Claims Examiners Yes No Number of Employees NeededPlease enter a number greater than or equal to 1.Workers' Compensation Assistant / Junior Examiners Yes No Number of Employees NeededPlease enter a number greater than or equal to 1.Workers' Compensation Claims Assistants Yes No Number of Employees NeededPlease enter a number greater than or equal to 1.Data Entry Yes No Number of Employees NeededPlease enter a number greater than or equal to 1.File Clerks Yes No Number of Employees NeededPlease enter a number greater than or equal to 1.Clerical Support Yes No Number of Employees NeededPlease enter a number greater than or equal to 1.Personnel Start Date* MM slash DD slash YYYY Length of Assignment* EmailThis field is for validation purposes and should be left unchanged. how can we help you? Contact Tuell & Associates by submitting a business inquiry online. contacts
