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Supplier and Independent Recruiter Registration Form
Welcome to Supplier and Recruiter Registration Form. You will receive your login details at the email address provided upon approval.
Register As
Supplier Company
Independent Recruiter
Details
Enter details requested below. You are not required to enter Company Name if you are registering as an Independent Recruiter.
Person representing a company must enter their Company Name. Additional users for a company can be created from primary account login.
Company Name*
Enter following details of Independent Recruiter or primary user of the Supplier Company
First Name*
Middle Name
Last Name*
Telephone No.*
Cellular No.
Email Id*
Re-Enter Email Id*
Address 1*
Address 2
Country*
Select Country Name
USA
Canada
Mexico
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bophuthatswana
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde Island
Cayman Islands
Central Africa
Chad
Channel Islands
Chile
China, Peoples Republic
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros Islands
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Easter Island
Ecuador
Egypt
El Salvador
England
Equatorial Guinea
Estonia
Ethiopia
Falkland Islands
Faeroe Islands
Fiji
Finland
France
French Guyana
French Polynesia
Gabon
Gambia
Georgia Republic
Germany
Gibraltar
Greece
Greenland
Grenada
Guadeloupe (French)
Guatemala
Guernsey Island
Guinea Bissau
Guinea
Guyana
Haiti
Heard and McDonald Isls
Honduras
Hong Kong
Hungary
Iceland
India
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey Island
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Martinique (French)
Mauritania
Mauritius
Mayotte
Micronesia
Moldavia
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands Antilles
Netherlands
New Caledonia (French)
New Zealand
Nicaragua
Niger
Niue
Norfolk Island
North Korea
Northern Ireland
Norway
Oman
Pakistan
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Polynesia (French)
Portugal
Qatar
Reunion Island
Romania
Russia
Rwanda
S.Georgia Sandwich Isls
Sao Tome, Principe
San Marino
Saudi Arabia
Scotland
Senegal
Serbia
Seychelles
Shetland
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
St. Helena
St. Lucia
St. Pierre Miquelon
St. Martins
St. Kitts Nevis Anguilla
St. Vincent Grenadines
Sudan
Suriname
Svalbard Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Tajikistan
Taiwan
Tahiti
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Isls
Tuvalu
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands (Brit)
Wales
Wallis Futuna Islands
Western Sahara
Western Samoa
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
State*
Select State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
City*
Zip Code*
No. of Employees*
Website Address
Description*
Check the Certification(s) your Company has
Minority Owned Certified Business
Small Certified Business
Woman Owned Business
Veteran-Owned Small Business
8A Certified
ISO Certified
CMM Certified
Where Did You Hear About Us
Select Answer
SkillGalaxy Email
SkillGalaxy Newsletter
From A Website
TV Commercial
A Friend
Newspaper Advertisement
SkillGalaxy Personnel
Other