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Jobish 1

This document outlines information required for a candidate and their employer to be considered for a government agency project. It requests details about the candidate like name, date of birth, visa status, work experience, education, and contact information. It also requires information about the candidate's current employer like company name, address, contact person, and federal ID. Additionally, it asks for recruiter details if applicable. The form notes that supplying correct information is mandatory to avoid disqualification from the project.

Uploaded by

Chirantar Kumar
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© © All Rights Reserved
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232 views2 pages

Jobish 1

This document outlines information required for a candidate and their employer to be considered for a government agency project. It requests details about the candidate like name, date of birth, visa status, work experience, education, and contact information. It also requires information about the candidate's current employer like company name, address, contact person, and federal ID. Additionally, it asks for recruiter details if applicable. The form notes that supplying correct information is mandatory to avoid disqualification from the project.

Uploaded by

Chirantar Kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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PROPOSED CANDIDATE & EMPLOYER INFORMATION SHEET

NOTE: This information is required as the project engagement is with GOVERNMENT AGENCY, and supplying
correct information is mandatory to avoid any candidate /supplier disqualification.

CANDIDATE DETAILS - Candidate Response Attach following


REQUIRED documents
 Candidate Name: First Copy of Driver’s
Name, Middle, Last
JOBISH.K.SOMASUNDARAN License/Received
Name (as in passport/ Copy of Passport
driver’s license)
 Other Names Used NA
 Social Security # 5541 Last 4 digits
 Year of Birth 1981
 Visa Status: EAD-GC Copy of H1B/
H1B/EAD- Received
GC/TN/Green Green Card/EAD-
Card/US Citizen GC/TN
 H1B /EAD-GC/TN visa 05/18/2018
-Valid Till (date)
 Date of Arrival in US? 2011 Month/Year
 Work Experience
 Years of Work 11 years+
Experience
 How long worked in US? 6 years+ Complete attached
Reference Form
 Education Details
 Degrees (List) B.Tech Copy of the degree
certificates
 Name of Calicut University
College/University,
Location
 Year of Graduation 2004
 Certifications, if any In resume Certificates, as
appropriate
Provide authentication
links
 Other
 Your Mobile Phone # 415 318 9794
 Your Contact Email [email protected]
 Your LinkedIn Profile Not there
(provide link)
 Your Availability Immediately
(Immediately/2 weeks)
 Your Current Location Redondo Beach, CA
 Willing to Relocate - Yes Yes
or No?
 Anyone you know in No
IPCS –
Staff/Consultant?
 Date your last project July 2017
ended?
 Attach your current (you may use your smartphone to take your picture)
photo
 Do you have recent Yes
background check
report? Yes or No

EMPLOYER DETAILS** – Company holding Candidate’s GC/H1B/EAD/TN Visa


 Employer Name + Web site Mastech Digital , http://www.mastechdigital.com/
 Employer registered address in the 1305 Cherrington Parkway
US Building 210, Suite 400
Moon Township, PA 15108
 Contact Person Name – Management Raju Ramanna,
Executive/CEO/Owner** (Not Recruiter)
Sr. Accounts Manager
 Title Sr. Accounts Manager
 Office Phone # 510-713-1201
 Email [email protected]
 Mobile
 Federal ID
 D&B #
 E-Verify Requirement – mandatory Upon confirmation of the candidate, Employer will
(You need to be an E-Verify Company) provide copy of candidate’s E-Verify clearance
 Background Check Required - supplier to provide completed copy of the
background check if already done and/or after selection of
the candidate
**This info is important for contacting Company Owner/Executive in case of any candidate emergency or any
critical issues

RECRUITER DETAILS
 Recruiter Name Chirantar Kumar
 Location San Jose, CA
 Phone # 877-884-8834 (2072)
 Email [email protected]
 Mobile
 Rate /Hour for the proposed candidate
Note: All fields are mandatory fields. Provide correct information. Completed Form should be send to
IPCS ASAP.

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