The forms below will be submitted via this website.

Application for Services


Fill out this form if you would like to start using Headcount’s services.

New Hire Form


Fill out this form if you are signing on a new employee. This form will provide us basic information about the employee, including bill rates and pay rates.

New Client Company


Fill out this form if you are signing on a new client. This form will provide us with basic information about the client company including contact information and payment terms.

Employee Change Form


Fill out this form if you need to make a change to the employee records for an employee already paid by Headcount who is not changing assignments. For employees not currently in Headcount’s system, or an employee changing which client company they work for, please refer to the New Hire Form.

Client Company Change Form


Fill out this form if you need to make a change to an existing client’s records. This form will provide us with new contact information or rate changes. To add an employee, see the New Hire form. For a client not currently on record with Headcount, please use the New Client Company form.

Exit Interview Form


Please fill out this form whenever an employee’s assignment is completed or terminated. This form will provide us with term dates and an explanation for why the employee is no longer working.

Work Accident Report Form


Fill out this form if an employee reports being injured on an assignment. This form will provide us with information about the incident.