Become a NYSA Member

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CLICK HERE TO DOWNLOAD A MEMBERSHIP APPLICATION.

For information about NYSA

please contact:

Jennifer Kelley
Executive Director
jennifer@nystaffing.org

Amy Rothe
Director of Special Events
arothe@nystaffing.org

110 East 42nd Street, Suite 802

New York, NY 10017

P:646.723.3215
T:800.264.7029
F:646.723.3216

info@nystaffing.org

MEMBERSHIP APPLICATION

Thank you for expressing interesting in becoming a Member in the New York Staffing Association (NYSA). If accepted, Membership is valid from January 1 through December 31.

Your company is eligible for membership in the New York Staffing Association if it is a firm operating a temporary personnel service or permanent (direct hire) staffing company with one or more offices within the state of New York or conducts business in the state of New York. Only Active Members (not industry partners) have voting privileges or may hold office in NYSA.

The following company wishes to apply for membership in the New York Staffing Association (NYSA), a corporation organized and existing under the Not-for-Profit law of the State of New York. By executing this application, your company affirms it:

A. 1. Has no affiliation with other member firms of this Association, except as otherwise noted

2. Has made no misrepresentations in this application for membership

3. Shall adhere to the principles of the Association as reflected in its Charter, By-Laws, and Code of Ethics

B. As an NYSA Member Company, your company agrees to follow the NYSA Code of Ethics when engaging in temporary employment services. Therefore we recognize the following responsibilities to our employees on temporary assignments:

1. Not to charge them any fees or percentages for sending them on assignments

2. To pay them promptly at set and stated intervals

3. To pay, contribute, or withhold all taxes and insurance required by city, state or federal governments

4. To adhere to any other laws and regulations governing employers

Please review the NYSA Code of Ethics before completing this application. Your admittance into the association is contingent upon your agreement and compliance with this code.

NYSA Membership Dues Invoice

As a condition of active membership in The New York Staffing Association, the undersigned agrees to pay to NYSA the following annual dues (note: all dues paid per year – per company) for the year.

Please review the following NYSA Membership levels and select the one (below) that describes your firms:

· Metro—Level I (New York City) $1500 ($10+M Rev)

· Metro– Level II (New York City) $900 ($9.9M or Below Rev)

· Albany $400

· Buffalo $400

· Long Island $400

· Rochester $400

· Westchester $400

At Large Member $400

Please complete the following information so that we can review your application:

Company Information
Company Name:
Website:
Main Phone:
Fax:
Address Street 1:
Address Street 2:
City:
State:
Zip Code:	(5 digits)
# Branch Offices:
Annual Estimated Revenue:
# of Staff Members:
Does your business own any part of a staffing service operating under another name?:
If yes, give the name (s):
Applicant Information
Applicant 1:
Title:
Direct Phone:
Mobile Phone:
Email:
# of years in current position:
Applicant 2:
Title:
Direct Phone:
Mobile Phone:
Email:
# of years in current position:
Have you ever been a member of NYSA?:
Are you a member of ASA (American Staffing Association)?:
Have you reviewed and are willing to comply with the NYSA Code of Ethics?:
Background Information
Company is a:
Business is a:
If national, are you a branch of a firm with its principal offices outside of NY State?
Does your business derive its principal revenue (more than 50%) from providing temporary services?:
Are you also engaged in the permanent (direct hire) employment agency business?:
Do you place freelancers or independent contractors on a temporary basis?:
Has your company ever operated under another name? If so, please provide the name here:
How did you hear about NYSA?:
What was the determining factor in your decision to join NYSA?:
Would you be interested in serving on our Board of Directors?:
References
How long have you been providing staffing services?
	If you have been providing temporary and/or staffing services for less than one year, please give the name and telephone number of two business references that NYSA may contact:
Company 1:
Contact:
Title:
Phone:
Company 2:
Contact:
Title:
Email:
Phone:
Email:
Payment Information
Please select the membership level that best describes your company:
If paying by credit card, please select one of the following:
Card Number:
Company Name:
Name on card:
Billing address:
City:
State:
Zip Code:
Exp Date:
Security code on card:	(last 3 digits on back of card or 4 digits in the front of AMEX)
If paying by check or money order:	Please make your payment to: New York Staffing. Please mail your payment to: New York Staffing Association Attn: Jennifer Kelley 110 E. 42nd St., Ste. 802 New York, NY 10017 646-723-3216 Fax
Other Information
Comments:	Enter comments here!
	I authorize the New York Staffing Association to charge my credit card for the amount indicated above.