Following is a Questionnaire that we have developed over the years for our files, and allows us to have a better and more professional understanding of the background of those we agree to represent in the market place.

  • IT IS IMPERATIVE THAT YOU Answer ALL applicable questions
    (do NOT answer with "See Resume")

This information, along with the information we can glean from your resume, will allow us to professionally represent your needs, technical talents, and financial requirements to potential employers who fit your geographic preferences.

Name

Salutation

Ms. Mrs. Mr.

First Name

Last Name

Middle Initial

Preferred Name

 
Address

Street

City

State

Zip Code

Area Code

(ex. 999)

Phone Number

(ex. 999-9999)

Email

 
Referred By

Referred By

If Other

(ex. Flipdog, Headhunter, JobsOnLine, etc.)
 
Current Employer

Company

Division

Period To/From

Position/Title

Reporting To

City

State

Work Area Code

(ex. 999)

Work Number

(ex. 999-9999)

Work Email

Contact at Work

By Email Emergency Use Only Okay to Contact
By Phone Emergency Use Only Okay to Contact

Still Employed

Yes No

If No, last day

(ex. MM/DD/YY)

Date Available for New Employment

(ex. MM/DD/YY)

Reason(s) Seeking New Employment

 
Salary (in $k/yr)

Present or Last (if currently unemployed)

Desired

Minimum Acceptable

Open to Contract

Yes No

If Yes, Minimum Salary

($/hr)
 
Position/Title Desired

First Choice

Second Choice

 
Most Recent Degree(s)/Certification(s) Received

Degree #1

 

Degree Type

BS BA Masters PhD Certification

Major

Minor

Name of Institution

Date of Graduation

(ex. mm/yy)

GPA CUM

Degree #2

 

Degree Type

BS BA Masters PhD Certification

Major

Minor

Name of Institution

Date of Graduation

(ex. mm/yy)

GPA CUM

 
Summary
Assist us in writing a brief "summary" of exactly what you would like a potential new employer to know about yourself
(talents, work ethic, technical expertise, etc).
 
List pertinent/specific skills/buzz words that may be of special interest to a potential new Employer:
 
List areas of particular interest, or technical areas you would like to see your career taking you:
 
In 25 words or less, tell us what you like about your current job:
 
In 25 words or less, tell us what you would like to change about your current job.
 
In 25 word or less, tell us what you are hoping for in a new opportunity:
 
List industries in which you have a background and/or interest in working:
(ex. Auto / Computer / DoD / DoE / Electronics / Software)
 
Relocation
Please check your geographic preferences. If you would like, you can be as specific as naming a city and state.
(NOTE: The broader your geographic restrictions the more opportunities you will have to consider)
 
Open To All
 Northeast
 Southeast
Mid Atlantic
 Northwest
 Southwest
Midwest
 Rockies
 West Coast
 
Comments for geographic preferences:
 
Geographic areas you would definitely NOT be open to:
 
Personal Information

Marital Status

Married Single

Living Arrangements

Own Rent

Citizenship

US Other
 

If Other, enter country

 

Permanent US Resident

Yes No

Current Visa Status

Active Expired

Visa Type

 
Security Clearance

Type

Confidential
Secret
Top Secret

Access

SCI
EBI
SBI
SSBI

Status

Active Past
 

If Past, date debriefed (ex. MM/DD/YY)

 

Polygraph

Y N
 

If Yes, enter date (ex. MM/DD/YY)

 
Minority Candidacy
Due to the nature of our Government Contractors they are often SEEKING minority candidates so they can be in-line with the government recommendations regarding ethnic and sexual diversity hiring guidelines. Please do not be offended by the following question (a question that I as an employer could not ask but, as your representative to potential employment opportunities, it behooves me to know)
 

Disabled

Yes No
 

If Yes, explain

 

National Origin

 

If Other, please explain

 
Travel

Percent Willing to Travel

(ex. 50)
 
Important Note
This form is for the sake of information ONLY and is NOT set in concrete - do not let it be a source of concern. . Take only a few minutes to fill it out completely. . There is no need to "ponder" any question! We are looking for facts and "gut" feelings.