GlaxoSmithKline - Recruitment Firm Recommended
Provider Application

Please complete this form to be considered for GlaxoSmithKline's
recommended provider list.  Note: Please complete the entire form,
insufficient applications will not be considered.
Number of Positions
filled in 2005 by
minority candidates: (US
Only)
List Clients where 5 or
more positions (min.)
were filled in 2005 :
May we contact these
clients as a reference:
YES                                NO
List Number of Positions filled in 2005 by specialty:
Select type of firm:  
(select from drop down
box, use ctrl for more
than one selection)
Where can your
company's financial
information be found?  
(publicly owned
companies only)
YES                                NO
Is your firm willing to
accept accountability
for your candidates by
offering a one year
guarantee?
YES                                NO
List your result ratio of
candidates presented vs.
hired for 2005:
What hiring ratio could
GSK expect from your
firm?  (presented vs.
hired)
YES                                NO
Has your firm been
nominated by a GSK
Recruitment Manager,
HR Professional, or
Hiring Manager?  (if yes,
by whom?)
Please provide us with
proposed fees.  (optional)
Adverse Event Reporting:
This Web site is not for medical emergencies. Please do not use this
Web site for Adverse Event Reporting. If you are a physician, follow
the procedures required by your country's regulations.If you want to
report an adverse event in the United States, please contact GSK at
1-888-825-5249.If you reside in the UK and want to report an adverse
event in the United States, please contact GSK at 44 (0) 208 047 5000.
Updated May 29, 2005 - © 2001-2005 GlaxoSmithKline - All Rights Reserved


Submit your
Companies
Credentials
Name of Recruitment
Agency/Staffing firm:
Name of Parent
company:  (if applicable)
Key Contact Phone no:
Key Contact Fax:
Key Contact Email:
Mailing Street address:
Street address contd
City:
County/State:
Zip Code:
Country:
Geographical Coverage
of company:
Areas of Specialty:  
(maximum of 3 areas)
Number of Positions
filled in 2005:
US:
UK:
INTL:
Accounting:
Clinical Development:
Drug Discovery:
Engineering:
Finance:
HR:
IT:
Laboratory:
Legal:
Manufacturing:
Marketing:
Preclinical:
Sales:
Scientific:
Supply Chain:
Other:
Average compensation
per filled position:
Number of recruiters &
support staff:
Are you minority owned?
 (US only)
Have you placed
candidates at GSK
previously?
Comments: