Online Job Order Sheet – Rexburg 2/4/2015 Return

*Order Requested By

*Assignment Start Date

*Number of Workers Needed

Order Information

*Company Name

*Job Site Address

*Report To

*Job Site Phone

* Time

Mobile

*Job Description

PO Number

Special Qualifications

Employee Requested

Directions to Site

Cross Streets

Safety Equipment Needed

Hard HatBootsGlovesBack BraceSafety GlassesSafety VestFlagging PaddleHearing ProtectionOther

Safety - If Other

How Did You Hear About Gem State Staffing?

MailerWord of MouthNewspaperSales CallYellow PagesAdvertisingGoogle

New Customer Information

only required for first time orders

Customer Name

Code

Billing Address

Phone

Fax

Federal Tax ID