Boiler Saftey Temporary Staffing Services Request Form.pdf
PDF 322 KB Posted
- Contract number
- 24-416CMS-BOSS4-P-56144
- Issued by
- Illinois
About this file
Summary
This is a Request for Placement Form for Temporary Staffing Services issued by the State of Illinois for Fiscal Year 2026. The form is part of the State of Illinois Invitation for Bid (IFB) Standard Business Terms and Conditions (V.20.1). The end-user is Jodi Schrage (Jodi.Schrage@Illinois.gov), and all staffing requests must be coordinated through the end-user liaison. The supervisor responsible for timesheet approval is Pat Polick (Patrick.Polick@Illinois.gov, 217/836-0821), and weekly invoices are to be directed to Ronny.Wickenhauser@illinois.gov.
The request is for one full-time temporary staffing employee with work hours from 8:00 a.m. to 4:00 p.m. daily, including a one-hour lunch period. The assignment is scheduled to begin on April 13, 2026, with an anticipated end date of October 12, 2026. The employee will report to 1035 Stevenson Drive, Springfield, Illinois 62703. No additional skill requirements were selected from the available options, which include certifications, language abilities, computer proficiency, and specialized skills. The form requires attachment to a Release Requisition/Purchase Order within BidBuy and must include vendor contact information, contract number, and email and phone details for the staffing vendor.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| FBMWIEC CMS 104 Job Description Form.pdf |
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
State of Illinois IFB Contract: Standard Business Terms and Conditions V.20.1
Section 6 Exhibit A
REQUEST FOR PLACEMENT FORM
TEMPORARY STAFFING SERVICES
FY _26_
ALL REQUESTS FOR TEMPORARY STAFFING EMPLOYEES WILL BE ARRANGED WITH THE VENDOR
THROUGH THE END-USER LIAISON ONLY.
End-User: _______Jodi Schrage___________________________End-User Contact: _Jodi.Schrage@Illinois.gov___________________________ ☐ New Request ☐ Renewal of Current Temporary Worker ☐ Request Change in Current Order
Number of temporary staffing employees requested for this assignment: ________1_____________________
If duties vary for each temporary employee, a separate Release Requisition/Purchase Order must be submitted for each request.
Requested Start Date: _______4/13/2026__________________ Anticipated End Date: ________10/12/206________________
If the start date is RESCHEDULED or CANCELLED due to change in need, please notify the End-User Liaison IMMEDIATELY by e-mail. The End-User Liaison will notify the Vendor to change or terminate the search for candidates.
☐ PartTime ☐ FullTime Daily Work Hours: From: 8am am/pm To: 4p am/pm
Lunch ☐ 1 Hour ☐ 1/2 Hour Total Hours Per Day
Signature of Supervisor signing weekly timesheets: _________________________ Print Supervisor’s Name: ___Pat Polick______________________ Supervisor’s Phone #: _________________________ Supervisor’s Email: ______Patrick.Polick@Illinois.gov___________________
Name of Administrator/designee signing weekly approval form (if required): _________________________
Email Where Weekly Invoices are Sent: ___Ronny.Wickenhauser@illinois.gov______________________
Address Where Temporary Employee(s) Report to Work (building, floor, room, street address, etc., including parking instructions, anticipated tolls):
Person to Report to First Day: _1035 Stevenson Drive Springfield IL 62703________________________
Special Conditions (request previous temporary staff, pre-interview, demeanor for executive office, background check requirement, etc.):
This form must be attached to the Release Requisition/Purchase Order within BidBuy at https://www.bidbuy.illinois.gov/bso/ which identifies all Job Classifications and Additional Skills available through each Vendor.
Please specify the Additional Skill Requirements (as requested through BidBuy) ☐ Bending/ Lifting 50 lbs:
☐ Bendng/Lifting 75 lbs:
☐ Drivers Lisences/ Class D:
☐ Hand Truck:
☐ Notary:
217/836-0821 https://www.bidbuy.illinois.gov/bso/ Amy James Highlight
Amy James Highlight
Amy James Highlight
Amy James Highlight
Amy James Highlight
State of Illinois IFB Contract: Standard Business Terms and Conditions V.20.1
☐ High school diploma
☐ Microfilm Operator
☐ Keyboarding 35 wpm
☐ Keyboarding 50 wpm
☐ Sign language
☐ Bilingual (specify language):
☐ Computer Skills (specify programs)
☐ Advanced Computer Skills (specify programs):
☐ Agency Defined Position with attached Job Description:
Vendor Contact (Printed First and Last Name):___________________________________
Vendor Contract #:__________________________________
Vendor Email:______________________________________
Vendor Phone:_____________________________________
Date:_____________________________________________
Amy James Highlight
| Executed Contract P-56143 Rose 26.pdf |
| Executed Contract P-56143 Rose 27.pdf |
File details come from the government source that posted it. Updated .