Candidate Information Form

In order to expedite our presentation of your background to clients, I need some additional information. Please take a moment to fill out our short application. We have tried to make this as brief and easy as possible. This additional information is necessary to make the best presentations possible and will complete your internal file. I appreciate your cooperation in this and am looking forward to working with you in your job search.

Please complete all fields. If a question is Not Applicable please put N/A in the space provided.

Date *

Name *

First

Middle

Last

Address 1

Address 2

City

State / Province

Zip Code

Home Phone *

Work Phone

Mobile / Other

Email *

Email

Confirm Email

Do we have your permission to share your background with our affiliates offices? It will not cost you any money, but will greatly enhance your visibility in the expanding job market.

Yes
No

Are You Currently Employed?

Yes
No

If no, when was the last day you worked

Most Recent Employer

Most Recent Title

Company Product or Services

Most Recent Salary

Bonus (if applicable)

Desired Salary

Minimum Salary

Reason for Job Search

Desired Position

Please list the jobs or positions you feel qualified for (i.e. Design Engineer, Manager, Senior Technical Lead, Manufacturing Engineer)

What Industries Have You Worked In?

With what PROCESSES/SKILLS are you experienced?

(Metal fab, Injection Molding, Machining, Stamping, Chemical Batch Processes, etc.)

What PRODUCTS are you experienced with?

(Circuits, Valves, Plastic Containers, Air Conditioners, Motors, Automotive Parts, etc.)

Education

Year of Graduation

Additional Degrees and Certifications

Have You Ever Managed People?

Yes
No

If so how many at one time?

Open to Travel?

Yes
No

Percentage of travel open to?

Citizenship (US):

Yes
No

If No, What is Your Visa Status

Please Select the Appropriate Status of Your Current Residence

Number of People Relocating

Relocation - Regions "Willing To Consider"

What is your preferred location?

Please use this space to give us any additional information that you feel would be helpful to us in finding the ideal opportunity for you. This information should include things like career accomplishments, areas of expertise, additional training or certifications, etc.

Email