New Jersey Manufacturing Extension Program, Inc.
Consulting Resource Application
A. General Information
Organization Name
Address
City
County
Phone Number
Fax Number
Email address
State
Zip Code
WWW Home Page
B. Contact Information
Primary Contact
Phone Number
Fax Number
Address
(if different than
above)
City
Additional Contact
Phone Number
Fax Number
Address
(if different than
above)
City
Ext
Title
Additional Phone Number
Email
State
Ext
Zip Code
Title
Additional Phone Number
Email
State
Zip Code
C. Organization Information
1. Is your organization a:
Private company
Community college
4-year college or university
Other education or training organization
Federal lab
2. Year Established
Economic Development agency
Professional or trade organization
Utility company
Other (please specify)
3. Number of Full Time Employees
4. Do you have professional liability insurance or the equivalent?
If yes, please indicate the source of this insurance and its expiration date:
Source:
Yes
No
Expires:
5. Please indicate the geographic area in which you are willing to work:
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New Jersey Manufacturing Extension Program, Inc.
D. Qualifications
1. Please provide a descriptive summary of your expertise and capabilities (up to 100 words): Include a
response to the following questions, either here, in an email cover letter or in an electronic copy of your
service description (samples and blanks are included on the NJEMP website):
What do you do?
How will NJMEP’s clients benefit from your services?
How can NJMEP's field agents (FAs) who are sales consultants identify and qualify potential clients?
How do you price your services?
How can we create a win-win-win situation for the client, you and NJMEP?
2. Distinctions: Please provide any relevant and active memberships, certifications, licenses, awards, and
other notable distinctions.
3. Principal role: Please check the one category below that best describes the services your organization
most often provides to manufacturers:
Management consulting
Training services
Engineering services
Software development & application
4. Area of expertise: Please rank, in order of their importance, up to four of the expertise codes listed below,
which best describe your particular area(s) of expertise:
#1
#2
#3
#4
Area of Expertise
1. Automation / Robotics
9. Human Resources
2. Business Systems / Business Management
10. Market Development
3. CAD/CAM/CAE
11. Material Engineering
4. Control Systems / Integration
12. Plant Layout / Manufacturing Cells
5. EDI / Communications
13. Process Improvements
6. Environmental
14. Product Development and Design
7. Financial
15. Quality / Inspection
8. General
5. Industry focus: Please rank in the order of their importance, up to four of the industry codes listed below,
which best describe the particular industry(ies) with which you have worked.
#1
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#2
#3
#4
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New Jersey Manufacturing Extension Program, Inc.
Industry Focus – Standard Industry Codes
20
21
22
23
24
25
26
27
28
29
Food Products
Tobacco Products
Textile Mill Products
Apparel and Other Textile Products
Lumber and Wood Products
Furniture and Fixtures
Paper and Allied Paper
Printing and Publishing
Chemical and Allied Products
Petroleum and Coal Products
30
31
32
33
34
35
36
37
38
39
Rubber and Misc. Plastic Products
Leather Products
Stone, Clay, Glass Products
Primary Metal Industries
Fabricated Metal Products
Industrial Machinery and Equipment
Electronic / Electric Equipment
Transportation Equipment
Instruments and Related Products
Miscellaneous Manufacturing
What do you see as the top two emerging initiatives in the industries you serve?
6. Activity: Please indicate how many different clients you have served as a consultant in the past two years:
clients
E. References:
Please provide references from at least three clients for which your organization has served as a consultant. It is
your responsibility to forward the “Reference Questionnaire”, which is on page 5 in this application, to each
reference with a request to complete and submit directly to [email protected] or fax to 973 – 860 – 4637 or mail to:
NJMEP
520 Speedwell Avenue, Suite 116
Morris Plains, NJ 07950
Attn: John W. Kennedy, COO
F. Non-Competition:
Consultant hereby agrees and covenants that during, and for one (1) full year after expiration or termination of
the Agreement, Consultant shall not, in the State of New Jersey, either as principal, partner, agent, employee,
director, officer or in any other capacity whatsoever: (1) perform, directly or indirectly, any services similar to
those provided by NJMEP and/or its affiliates and/or subsidiaries to or on behalf of any individual, firm,
partnership, company, corporation and/or other entity to whom NJMEP introduced the Consultant and/or for
whom Consultant performed services in connection with the Agreement or (2) solicit any business similar to the
business engaged in by NJMEP from any individual, firm, partnership, company, corporation and/or other entity
to whom NJMEP introduced the Consultant and/or for whom Consultant performed services in connection with
the Agreement.
Please print and sign below to indicate (1) that you believe the information you have provided is true and accurate
to the best of your knowledge (2) you have read and agree to any terms and conditions NJMEP has provided
above.
Printed Name of authorized signer:
Signed by
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____________________________________
Dated _____/____/_________
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New Jersey Manufacturing Extension Program, Inc.
G. Attachments
To help us present your credentials to clients most effectively, please attach the additional materials amounting to
no more than 10 pages:



Brochure or other marketing materials
Additional letter(s) of reference (optional)
Samples of Work (optional)
Thank you for your interest in working with NJMEP
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New Jersey Manufacturing Extension Program, Inc.
REFERENCE QUESTIONNAIRE
Consultant name:
Brief description of project(s):
Approximate dates of project:
From:
To:
Did you get the results you were expecting from the project?
Yes
No
Was the project completed within the timeframe you expected?
Yes
No
Would you hire this consultant again if a similar need arose in your company?
Yes
No
Would you recommend this consultant to your business acquaintances?
Yes
No
Do you have any additional comments you would like to make about your experience with this consultant?
Company name:
Name and title:
Phone:
Thank you.
Please submit to [email protected] or fax to 973 – 860 – 4637 or mail to:
NJMEP
520 Speedwell Avenue, Ste 116
Morris Plains, NJ07950
Attn: John W. Kennedy, COO
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