2025.10.20 Request for Placement Form Temp Chicago October25 GL Signed.pdf
PDF 4 MB Posted
- Contract number
- 24-416CMS-BOSS4-P-56142
- Issued by
- Illinois
About this file
The document is a Request for Placement Form for Temporary Service Workers for Fiscal Year 2025, issued by the Illinois Department of Insurance. The request is submitted through the vendor 22nd Century, located in Chicago, Cook County. The form is specifically for the Chief of Staff's Procurement/Administration division.
The request is for one full-time temporary worker, starting on 10/27/2025 and ending on 1/27/2026, with daily work hours from 8:30 am to 5:00 pm, including a 1-hour lunch break. The position requires a Telephone Operator classification, with additional skill requirements including a High School Diploma/GED, bilingual fluency (preferably Spanish), and computer software skills. The temporary worker will be expected to have basic knowledge of word processor programs, database software, and email systems. The form includes multiple approval signatures and was dated 10/20/2025, indicating internal authorization for the temporary worker placement.
View the file
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
REQUEST FOR PLACEMENT FORM
TEMPORARY SERVICE WORKERS
FY 2025
ALL REQUESTS FOR TEMPORARY SERVICE WORKERS WILL BE ARRANGED WITH THE VENDOR THROUGH THE USER
AGENCY CONTACT PERSON ONLY.
(This Section is For User Agency Contact Person Use Only)
Region Number: Vendor Name:
Date Vendor was notified:
City:
Time Vendor was notified: Pos Code:
Hourly Billing Rate: ____________ _
User Agency's Name: _____________ _ Division:
Bureau/Unit: County:
D New Request D Renewal of Current Temporary Worker D Request Change in Current Order
Number of temporary workers requested for this job order: __ _
If duties vary for each temporary worker, a separate form must be submitted for each request.
Requested Start Date: _____________ Anticipated End Date:
If the start date is RESCHEDULED or CANCELED due to change in need, please notify the agency contact person
IMMEDIATELY by e-mail. The Agency Contact Person will notify the Vendor to change or terminate the search for candidates.
Work Schedule
D Part-time D Full-time
Total hours per day: __
Daily work hours: Start time ___ _ End time ___ _
Lunch Hour: D 1 Hour D ½Hour
Work days are assumed to be Monday through Friday, unless noted here:
Without prior funding approval from the agency contact person, the vendor will ONLY be paid for the hours approved.
Temporary service workers will NOT be paid for holidays by the user agency.
Work location address: Billing address (if different than work location):
Supervisor/email for temp. employees: ___________________ Phone no. __________ _
Alternate Supervisor:
Administrator/designee signing weekly approval form (if required):
Signatures Supervisor signing weekly timesheets:
Alternate supervisor signing weekly timesheets:
Signature of Administrator or designee (if required):
Phone no.
10/20/2025
22nd Century
Chicago
Illinois Department of Insurance Chief of Staff
Procurement/Administration Cook
X
10/27/2025 1/27/2026
X 8:30 am 5:00 pm
7.5 X
Anne Brown Gerra Lyons
Anne Brown
217-782-1762
217-558-3753
Lisa.Badger Cross-Out
X
10/20/2025
10/20/2025
File details come from the government source that posted it. Updated .