Name:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

FAX we can use:

E-mail Address:

Relocation:

YES     NO

Current Employer

Current Position:

Current Employer:

Special skills/equipment needed to perform your duties:

What are your measurable accomplishments in this position:

Number of nights you
travel per week: 

Base Salary:

Commission (average):

Bonus (average):

How often?:

Last raise:

Do you have a company car?:

Do you have a car allowance?
If so, how much?:

Relocation Information

Significant other:

Occupation:

Children (names/ages):

Hometown:

Memberships:

Outside Interests:

Qualifiers

What are your strengths?:

What are your weaknesses?:

What do you like best about your current job?:

What do you like least about your current job?:

What are the unkept promises in your current employment?:

What changes would you like to happen to keep you with your current employer?:

What are the three top things you are looking for in your next opportunity?
Please list them in order of preference:

Are there any specific companies that you would like to work for?:

Are there any specific companies that you would NOT like to work for?:

Minimum compensation desired:

Minimum compensation required:

What is your preferred location:

How many nights are you willing
to travel, on average?:

Are you willing to commute:?

How many miles one-way?:

Interviewing

Consider that interviews occur Monday through Friday, during business hours, what days and times are best for you to interview?

Please list three options:

How much notice would you need
to provide your current employer
should you change jobs?: