Register - InGenesis, Inc

InGenesis Supplier Registration

Welcome to InGenesis’ Supplier Registration Portal. All suppliers interested in being considered for InGenesis procurement opportunities should register here.

Information provided during registration will be used to identify suppliers that demonstrate the ability to add value and provide high-quality goods and services that are competitively priced, reliable, and aligned with our business priorities.

Before beginning, please gather the following information:

     • Company contact information
     • Tax ID Number
     • Company history and capabilities overview
     • A list of your products/services offered
     • Details on service area covered or area in which your products are distributed

An acknowledgement receipt of your registration will be sent automatically when the completed company profile is submitted. Please note that registration as a supplier does not guarantee business with InGenesis, place your company on the list of approved suppliers, or require InGenesis to solicit requests for quotes or proposals. Registering as a supplier simply allows InGenesis to review your company information when searching for suppliers for new or upcoming opportunities. If there is a need for your products and/or services, you may be contacted by one of our purchasing representatives.

This information will be kept in our database and will be used to identify potential vendors for future opportunities. While InGenesis uses this supplier database to search for qualified vendors, inclusion in our database does not guarantee consideration for future procurement opportunities.

At any time, you may save your progress and come back at a later time with the 'Save and Continue Later' link at the bottom of the form. You will not be able to make changes once your registration is submitted.

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1. Company Identification
- 1. Company Name*
- 2. Parent Company (if applicable)
- 3. 9-digit Taxpayer Identification Number (EIN)*
- 4. Is your company publicly traded?*
  - Yes
  - No
- 5. DBA (if applicable)
- 6. Year of Incorporation*
- 7. Duns Number
- 8. Website Address*

9. Affiliated Companies

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2. Ownership
List the primary owner as well as any other owners of the company. Please ensure that all ownership is captured and that the summation of the Ownership % column is equal to 100.
1. Primary Owner*
Name Ownership %

2. Other Owner(s)

Name	Ownership %

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3. Corporate Contacts
Authorized Primary Contact
Must have the ability to bind the company
- 1. Name*
- 2. Email*
- 3. Title*
- 4. Phone*
Second Authorized Contact
Must have authority to make operational decisions on behalf of the company.
- 5. Name*
- 6. Email*
- 7. Title*
- 8. Phone*

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4. Address & Locations
- 1. Corporate Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

2. Branch Locations

Street Address	Address Line 2	City	State / Province / Region	Zip / Postal Code

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5. General Questionnaire
1. What is the number of non-billable employees in your organization for the last fiscal year end?*
2. What is the number of billable employees in your organization for the last fiscal year end?*
3. How many MSP programs did your company support for the last fiscal year end?*
4. State your current year interim YTD sales (estimated)*

5. Previous 3 years revenue*

Year	Revenue

6. Do you have a formal business plan to continue to provide services to our client in the event of a business interruption?*
- Yes
- No
7. Are you willing and able to access the Internet to receive and fulfill requisitions?*
- Yes
- No
8a. Does your company, or any affiliates of your company, have outstanding judgement or liens?*
- Yes
- No
8b. Please provide details about judgements or liens.
9a. Has your company, or any affiliates of your company, ever declared bankruptcy?*
- Yes
- No
9b. Please provide the date you declared bankruptcy
MM slash DD slash YYYY
10. Please describe any pending litigations or prior judgements relevant to services you offer to InGenesis.*
11a. Are you currently or have you ever operated under a different business name?*
- Yes
- No

11b. Previous Business Information

Business Name	Federal Employer Identification Number	Full Business Address	Business Phone Number

12a. Are you applying to support a specific InGenesis program?*
- Yes
- No
12b. If yes, pelase specify:*

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6. Past Performance & References

1. Please list your top 3 customers based on last 3 years revenue*

Customer Name	Primary Service Provided	Contract Period	Total Previous Year Revenue

2. Customer References*

Name	Entity/Corporation	Email	Phone Number

References should match customers listed above

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7. Capabilities & Service Listings
To better understand your capabilities please fill out the information below by labor category. The information provided should reflect the performance of your company as a whole and not for a specific program.
1. Do you provide Academic staffing?*
1b. Academic Staffing Capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
2. Do you provide Accounting & Finance staffing?*
2b. Accounting & Finance staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
3. Do you provide Business Professional staffing?*
3b. Business Professional staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
4. Do you provide Business Administrative/Clerical staffing?*
4b. Business Administrative/Clerical staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
5. Do you provide Correctional Facilities staffing?*
5b. Correctional Facilities staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
6. Do you provide Editorial & Media staffing?*
6b. Editorial & Media staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
7. Do you provide Emergency Management staffing?*
7b. Emergency Management staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
8. Do you provide Healthcare staffing?*
8b. Allied Health*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
8c. Dental*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
8d. Medical Coding*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
8e. Midlevel Providers*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
8f. Nursing FT/PT*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
8g. Nursing Travel*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
8h. Nursing PRN*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
8i. Mental Health*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
8j. Physicians*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
9. Do you provide Hospitality staffing?*
9b. Hospitality staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
10. Do you provide Human Resources staffing?*
10b. Human Resources staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
11. Do you provide Information Technology staffing?*
11b. Information Technology staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
12. Do you provide Light Industrial staffing?*
12b. Custodial/Housekeeping*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
12c. Equipment Operation*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
12d. Facilities Maintenance*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
13. Do you provide Operations & Logistics staffing?*
13b. Operations & Logistics staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
14. Do you provide Procurement & Supply Chain Management staffing?*
14b. Procurement & Supply Chain Management staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
15. Do you provide Security staffing?*
15b. Security staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
16. Do you provide Social Services & Nonprofit staffing?*
16b. Social Services & Nonprofit staffing capabilities*
# FTEs filled in your last fiscal year Revenue for your last fiscal year
17. Do you provide Surge/Emergency staffing?*
If yes, please provide details regarding your experience, including the dates, location, reason for the surge, your response, and the scope of services performed for each category below.
17b. Administrative*
17c. Allied Health*
17d. Nursing*
17e. Physicians*
17f. Other*
18. Service Listings*
- Contingent Labor
- Direct Hire
- IC
- Locum Tenens
- Payrolling
- Per Diem
- Retained Search
- RPO
- SOW
- Travelers
3. Other Capabilities

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8. Geographic Capabilities
Please select the geographic regions that your company is currently providing services. There is additional space at the bottom where you may add any comments or supporting information.
1. Region*
- United States - Midwest
- United States - Northeast
- United States - South
- United States - West
- APAC (Asia-Pacific)
- Canada
- EMEA (Europe, Middle East, Africa)
- Latin America (excluding Mexico)
- Mexico
2. Additional Comments

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9. Certifications
Please identify any certifications your company holds. Multiple selections are acceptable.

1. Diversity Certifications

Certification	Certifying Organization	Certification Number	Expiration Date

2. Company Certifications

Certification	Certifying Organization	Certification Number	Expiration Date

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10. Attachments
Please upload any relevant materials that support your capabilities. You may submit up to 10 files and each file must be 10MB or less in size.
Drop files here or

Max. file size: 10 MB, Max. files: 10.

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Registration Submission
You are about to submit your registration to InGenesis. By clicking "Submit" below, you are certifying that the information you provided is complete and accurate. Once submitted, you will not be able to make changes to this Registration.
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Step 1 of 12

InGenesis Supplier Registration

1. Company Identification

2. Ownership

3. Corporate Contacts

Authorized Primary Contact

Second Authorized Contact

4. Address & Locations

5. General Questionnaire

6. Past Performance & References

7. Capabilities & Service Listings

8. Geographic Capabilities

9. Certifications

10. Attachments

Registration Submission