ExecuSure - Membership Application

Apply for ExecuSure coverage

Applying for ExecuSure coverage takes just 3 easy steps.

Step 1: Please completely fill out the four-part application below to apply for ExecuSure coverage.
Step 2: Once submitted, your application will be sent to one of our staff for approval and quoting.
Step 3: You will receive updated status notifications of your application via e-mail.

Part #1: Your recruitment firm's information

First name:
Last name:
Company name:
Address 1:
Address 2:
City:
State:
Zip:
Email address:
Phone:
Fax:

Part #2: Recruitment firm applying for ExecuSure participation

Is this company part of a franchising system?

(A.) If you are part of a franchise recruitment firm, which franchise?

(B.) Number of years your firm has been with the franchise?

(C.) How many recruiters are on staff making permanent placements?

Please provide us with your website address

Part #3: Recruiter applying for ExecuSure participation

How many years have you been placing permanent employees?

Please describe the industries you specialize in:

Total number of placements made in the past 36 months:
(Have you been in business less than 36 months? Enter the total number placements to date)

How many of those placement made in the last 36 months are still in those positions:

What is the average fee charged per permanent placement?

What is your first-time interview to placement ratio?

What is your desired waiting period?

Part #4: Please attach the following information

Files accepted: .doc, .pdf, .txt, or .zip less than 1 megabyte each

Attach copy of recruiter bio/resume:

Attach sample copy of recruiting firm's placement contract, including fee schedule:

Phrase verification

Please verify your application by entering the code shown below

Discount Code

Enter your discount code: