WASS Membership Application

Name of Firm:

Name of Voting Representative:

Corporate Address:

Phone:

Email:

Website:

Number of Branch Offices:

Number of Franchises:

Number of Licenses:

Is your business operated as a separate, identifiable entity, which derives its principal revenue (at least 50%), from providing staffing services?
Yes No

If your business owns any part of a staffing service operating under another name, please provide that name:

List the company name, address, contact person, phone, and fax number for all WI branches and franchises:

If your business engages in the direct hire (permanent) agency business, please provide the name of the agency:

If your business is involved with employee leasing, please brief describe services:

How long have you been providing staffing services: (in year and months)

If less than one year, please list the name and business phone of two business references that WASS may contact. :

Describe any past experience you have had in the staffing industry:

How did you hear about WASS?

If you have attended a WASS Chapter meeting, please indicate when?

What was the determining factor in your decision to join WASS?

In which industries does your company specialize? Please select all that apply:

Please enter in the word you see below: