Customer Approval Form - Cornerstone Staffing Solutions, Inc.

Customer Information

Requested By*

Email*

Region/Area*

Branch*

Customer Name*

Client Type*

Avionte Customer Number*

Service Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Corporate Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Federal ID Number

State(s) where Employees will be placed*

Client Website

Timeline*

Type of Placements*

Job Description

If you are submitting more than one job title on this form, you need to answer the questions that follow for each specific job title.

Job Title (list all applicable job titles)*

Job Description

Or attach a Job Description

Drop files here or

Max. file size: 100 MB.

Hidden

Or attach a Job Description

Max. file size: 100 MB.

Physical Demands*

(i.e., lifting/pushing/pulling/carrying requirements in pounds/lbs.)

Machinery, Tools and/or Equipment to be Used*

Work Environment*

(e.g., Office, Distribution Center, Warehouse, Outdoors)

Personal Protective Equipment (PPE) Required*

Will the employee have access to cash, checks, or other negotiable instruments?*

Will the employee have access to names, addresses, social security numbers, phone numbers, or other PII?*

Will these positions require our employees to operate motor vehicles?*

Is the driver class A, B, and/or C?*

Please select all that apply:*

Radius (in miles) EE(s) will be driving*

GVW of the vehicles our EE(s) will be driving*

Are vehicles client-owned or leased?*

CDL endorsements required, if any*

Who is responsible for the maintenance of the vehicle(s)?*

If an employee is asked to operate his/her personal vehicle during his/her scheduled shift, the following is required and should be uploaded into Avionté:

Background check through one of our background screening vendors
Five-year MVR should be run annually on each EE.

The MVR must be clean (i.e., any DUI/DWI and/or two (2) or more moving violations found on the report will automatically prohibit the EE from driving activities on our behalf).

Copy of the valid EE’s driver’s license.
Copy of personal auto insurance for each EE evidencing current coverage.

This will need to be tracked to ensure we have evidence of current coverage on file as the coverage expires.

Associate Vehicle Operation Agreement signed by the EE.

Work Order Information

AP Contact Name*

AP Contact Email*

Total Number of Placements*

Estimated Annual Payroll*

Proposed Mark up*

Class Code(s)

OT Plan*

Estimated Weekly Billing*

Estimate Length of Assignment*

Payment Terms*