Staley Partner Qualification Webform

Fill out the form below to see if you qualify to become a Staley Partner. All fields are required for submission.

Staley Partner Qualification Webform

Company Name*
Contact Person*
Address*
City*
State*
Zip*
Telephone*
After Hours Contact Number*
Federal ID*
Email Address*
Email Address for Service Request*
Does your company have a current Safety Plan?*
Has your firm had any OSHA citations, fines, or jobsite violations within the most recent three (3) years?*
Customers may require that we be certified in the use of a lift and to have that certification on lifts. Do your electricians and/or technicians possess any lift certifications? (i.e. scissor lifts, boom lifts. Etc.)*
Please list all states and counties in which you work. Please Be Specific*
Union Company*
Year Business Started*
MM
DD
YYYY
Are you able to provide a certificate of insurance (COI) indicating coverage amounts of $1M in worker’s compensation and a general aggregate of $2M in G/L?*
Do you hold a state or city (county) electrical or low voltage license?*
Number of Full Time Employees*
Number of Techs*
Number of Electricians*
All Staley partners are required to perform drug testing and background checks. Does your company do a pre-employment background check?*
Do you require drug testing for employees?*
Do you have BICSI certified techs?*
What is your main line of work (Data, telecom, electrical)?*
What fields do you cover (fiber, cat5e, cat6, electrical, etc.)?*
Number of Company Owned Vehicles*
Do you have a 24x7x365 Service Group?*
Do you have Trained Fiber Optic Technicians?*
Do you have CAT5e & CAT6 Testers?*
What Kind?*
Do you have Fiber Testers?*
Can Field Technicians Bend Pipe?*
Machine Generated Labeler?*
Do you have experience with phone switches?*
Do you have experience with data switches?*
Do you have experience with security or CCTV?*
Do you have experience with wireless (installations, coverage surveys, etc.)?*
Do you have any experience in Access Control (wiring, devices, programming, etc.)?*
Are there any judgments, claims, arbitration proceedings, or suits pending/out-standing against your firm or Its officer or principals?*
Has your company filed any lawsuits or requested arbitration or mediation with regard to installation contracts within the last three (3) years?*
Has your company or any of its Owners declared Bankruptcy in last 5 years?*
Is your company owned or controlled by a parent or any other organization?*
Was there ever a project that you were not able to complete by the required deadline?*
Provide details below about the 2 largest projects completed in the last 12 months.
Project*
Company*
Address*
Telephone*
Your Contract Amount*
Project*
Company*
Address*
Telephone*
Your Contract Amount*
Electrician Hourly Rate*
Data Technician Hourly Rate*
Security Technician Rate*
Overtime Rate (if applicable):*
Typical Material Mark-Up*
Per Diem Rate*
Do you have a minimum hour policy?*
Hotel Rate*
Hourly Travel Rate*
(or) Mileage Rate*
How did you hear about Staley Technologies?*
Name*
Title*
Date*
Date Format: MM slash DD slash YYYY

Staley Partner Qualification Webform

Staley Partner Qualification Webform

OUR MISSION:

Do it right
the first time

9.3

Experienced

68 years

Scalable

8 offices

Trusted

90%

TURN KEY APPROACH

24/7 SERVICE AVAILABLE

QUALITY CONTROL

NATIONAL ROLLOUT

RELIABILITY

EXPERIENCE

Staley Partner Qualification Webform

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OUR MISSION:

Do it right the first time

9.3

Experienced

68 years

Scalable

8 offices

Trusted

90%

TURN KEY APPROACH

24/7 SERVICE AVAILABLE

QUALITY CONTROL

NATIONAL ROLLOUT

RELIABILITY

EXPERIENCE

Do it right
the first time