Submit a Placement

Once you've finalized all the details of a contract placement with your client company and contract candidate, your work is almost complete. You need to submit the necessary information to Top Echelon Contracting by completing the fields below. We use this information to generate the necessary legal agreements and employment paperwork for the client company and contractor. The accuracy of this information is essential.

Submit A Placement

Person completing these forms
(who we should contact for questions)
Person's Phone Number
Job Order Recruiter
First Name
Last Name
Agency Name:
Agency Code (if applicable):
Mail checks to:
If this is your first contract placement with Top Echelon Contracting, were you referred by another recruiter or industry trainer? *
Are you are a member of Top Echelon Network, LLC? Yes No
Is this a split placement with another recruiting agency?
Client Company Information
Client Company Name:
What product or service does the company provide?*
Billing Address:
Send Contract To
First Name
Last Name
Send Invoices To
First Name
Last Name
Can we email invoices?
Who will approve the candidate's timesheets (and expenses if applicable)?
First Name *
Last Name *
Email *  
Address at Work Location (no PO Boxes):

Street Address *  
City: *  
State: *
Zip: *
Many locations throughout the United States have passed laws that require employers to provide mandatory paid sick time to their employees. Top Echelon complies with all State and Municipal Paid Sick and Safe time laws and ordinances. Sick and Safe time rights are specific to the city or state in which the employee works. If your contractor is working in a location that requires mandatory paid sick time, Top Echelon will be providing paid leave to satisfy the sick time requirements. This will reduce your recruiter profit.
Bill Rate:
$ /hour
Overtime Bill Rate:
$ /hour
Is the Client Company sales tax exempt? If yes, please fax the exemption certificate or applicable tax exempt document to fax number (330)455-2374
We recommend that the recruiter negotiates a Conversion Fee Agreement directly with the client company so that the recruiter's conversion fee is in place in the event the client would like to hire the candidate as their employee. A suggested Letter Agreement for Contract Staff Recruiting Services is located here to assist the recruiter in this process.

If necessary, we can accommodate adding the recruiter's conversion fee into our Client Services Agreement. Please note however, Top Echelon Contracting does not take any responsibility for invoicing a conversion fee or enforcing any conversion fee in our Agreement.

Conversion Fee

Candidate Information
Candidate First Name *
Candidate Middle Name
Candidate Last Name *
Home Address: (Permanent - No PO Boxes):
Home Phone:
Cell Phone:
Email: *  
Job Title:
Is a drug screen required? *
NOTE: Top Echelon Contracting conducts a drug screen and criminal background check on every healthcare worker we employ. The cost will be split between Top Echelon Contracting (30%) and the recruiter (70%). The recruiter's share will be deducted from his or her first recruiter check from Top Echelon Contracting.
Start Date:

Estimated End Date:

Due to the new healthcare reform, Top Echelon Contracting must adhere to a minimum pay rate. Please contact our office if you anticipate paying the contractor less than $16.00 per hour to discuss.
Pay Rate:
$ /hr
Per Diem:
$ /hr  (if applicable)
Overtime Pay Rate:
$ /hr
Indicate if you want the candidate to receive Paid Leave Days. Note: This will reduce your recruiter commission.
Number of Paid Leave Days (accrued over 12 months)
Estimated Hours Worked per Week: *    
Please include a Job Description for Workers' Compensation coverage. Please list all other relevant information concerning the candidate: *  

Comment Box (please include any specific details pertaining to this placement)

Recruiter Checklist

Please check the appropriate column to indicate whether or not the recruiter has completed the item.

  Yes    No  
    Have you received a Quote from Top Echelon Contracting for this placement?
    Did you remind the Candidate that we need a completed, witnessed I-9 Form within 3 days of start date?
    Did you remind the Candidate that Top Echelon Contracting must receive all completed employment materials (contract, W-4, etc.) prior to their first payroll processing or their first check could be delayed?
    Did you remind the Candidate that the he or she MUST undergo a background check?
    Did you remind the Candidate that each week's time sheet must be received by 1:00 P.M. EST Monday, or the processing of the paycheck will be delayed?
    Did you remind the Candidate that paychecks are mailed each Thursday?
    Did you confirm the client company bill rates for Regular and Overtime hours?
    Did you remind the Client Company that they will be receiving a Client Services Agreement from Top Echelon which must be signed and returned prior to the Contractor starting work?
    Did you remind the Client Company that invoices are sent on a weekly basis?
    Did you remind the Client Company that all invoices are "Due Net 15"?
    Did you verify the duration of the contract with the Client Company (Start and End Dates)?
    Have you had the Client Company sign a specific CONVERSION FEE AGREEMENT with you?
    If necessary, would you like Top Echelon to include your specific CONVERSION FEE AGREEMENT in the Client Services Agreement we send to the Client? If so, please supply terms of the Conversion Fee to Top Echelon to be inserted into the Client Services Agreement.
NOTE: Top Echelon does not take a portion of your conversion fee; nor do we take any responsibility for invoicing a conversion fee in our contract or enforcing any conversion fee in our contract.
    Did you remind the Client Company that an authorized person MUST sign the Contractor's time sheet so it can be FAXED by 1:00 p.m. EST on Monday or processing of the Contractor's paycheck will be delayed?

NOTE: The information provided on these forms is used to generate binding legal documents. Please confirm that all information supplied to Top Echelon Contracting is accurate.

Confirmation Address:
A copy of this data will be emailed to the address entered here (for your records).