PROPOSED CANDIDATE & EMPLOYER INFORMATION SHEET

NOTE: This information is required as the project engagement is with GOVERNMENT AGENCY, and supplying
correct information is mandatory to avoid any candidate /supplier disqualification.

CANDIDATE DETAILS - Candidate Response Attach following

REQUIRED documents
 Candidate Name: First Copy of Driver’s
Name, Middle, Last
JOBISH.K.SOMASUNDARAN License/Received
Name (as in passport/ Copy of Passport
driver’s license)
 Other Names Used NA
 Social Security # 5541 Last 4 digits
 Year of Birth 1981
 Visa Status: EAD-GC Copy of H1B/
H1B/EAD- Received
GC/TN/Green Green Card/EAD-
Card/US Citizen GC/TN
 H1B /EAD-GC/TN visa 05/18/2018
-Valid Till (date)
 Date of Arrival in US? 2011 Month/Year
 Work Experience
 Years of Work 11 years+
Experience
 How long worked in US? 6 years+ Complete attached
Reference Form
 Education Details
 Degrees (List) B.Tech Copy of the degree
certificates
 Name of Calicut University
College/University,
Location
 Year of Graduation 2004
 Certifications, if any In resume Certificates, as
appropriate
Provide authentication
links
 Other
 Your Mobile Phone # 415 318 9794
 Your Contact Email jobish.ks11@gmail.com
 Your LinkedIn Profile Not there
(provide link)
 Your Availability Immediately
(Immediately/2 weeks)
 Your Current Location Redondo Beach, CA
 Willing to Relocate - Yes Yes
or No?
 Anyone you know in No
IPCS –
Staff/Consultant?
 Date your last project July 2017
ended?
  Attach your current (you may use your smartphone to take your picture)
photo
 Do you have recent Yes
background check
report? Yes or No

EMPLOYER DETAILS** – Company holding Candidate’s GC/H1B/EAD/TN Visa

 Employer Name + Web site Mastech Digital , http://www.mastechdigital.com/
 Employer registered address in the 1305 Cherrington Parkway
US Building 210, Suite 400
Moon Township, PA 15108
 Contact Person Name – Management Raju Ramanna,
Executive/CEO/Owner** (Not Recruiter)
Sr. Accounts Manager
 Title Sr. Accounts Manager
 Office Phone # 510-713-1201
 Email Raju.Ramanna@mastechdigital.com
 Mobile
 Federal ID
 D&B #
 E-Verify Requirement – mandatory Upon confirmation of the candidate, Employer will
(You need to be an E-Verify Company) provide copy of candidate’s E-Verify clearance
 Background Check Required - supplier to provide completed copy of the
background check if already done and/or after selection of
the candidate
**This info is important for contacting Company Owner/Executive in case of any candidate emergency or any
critical issues

RECRUITER DETAILS
 Recruiter Name Chirantar Kumar
 Location San Jose, CA
 Phone # 877-884-8834 (2072)
 Email Chirantar.Kumar@mastechdigital.com
 Mobile
 Rate /Hour for the proposed candidate
Note: All fields are mandatory fields. Provide correct information. Completed Form should be send to
IPCS ASAP.