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Pre-Screening Information
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4 Step Process
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This form is used to assist employment professionals in determining how well you match their requirements. Please be sure to be accurate when providing this information.
Contact Information:
First Name:
Last Name:
Email:
Address:
Home Phone:
City:
Cell Phone:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Professional Information
Title best describing your current/last position:
Education:
Select
BA/BS
Masters
Ph.D
J.D./LLD
Military
Some College
No College
Industry:
(Choose up to 5)
Advertising
Accounting / Finance
Aerospace & Defense
Agribusiness
Airlines
Alcoholic Beverages & Tobacco
Automotive
Banking
Biotechnology
Broadcasting
Chemical
Computers: Hardware
Computers: Networking
Computers: Software
Construction
Consumer Goods
Educational Services
Environmental
Facilities Management
Financial Services
Foods & Nonalcoholic Beverages
Franchising / Business Ownership
Healthcare: Managed Care
Healthcare: Pharmaceuticals
Healthcare: Products & Supplies
Hospitality
Hotel / Resort
Import / Export
Industrial
Insurance
Internet / E-Commerce
Investment Services
Lodging & Gaming
Manufacturing
Medical
Natural Gas
Paper & Forest Products
Packaging
Publishing
Recreation
Restaurants
Retail
Securities
Semiconductors
Telecommunications: Wireless
Telecommunications: Hardline
Textile
Transportation
Travel & Tourism
Warehousing
Waste Management
Wholesaling
Wood Products
Currently Employed?
yes
no
If not, how long have you been unemployed?
Select
Less than 15 days
15-30 days
30-45 days
45-60 days
Longer than 60 days
Current Income:
Select
Under $50,000
50-70
70-90
90-120
120-150
150+
Desired Income:
Select
Under $50,000
50-70
70-90
90-120
120-150
150+
Years Experience:
Select
1-5
6-10
11-15
16-20
21-25
26+
Have you had any interviews that excited you in the last 30 days?
yes
no
If so, have you scheduled a follow up interview?
yes
no
not sure
Date Scheduled:
Do you have credible job offers pending?
yes
no
If so, what is the current status of this offer?
Select
Accepted, but still looking
Rejected
Evaluating Offer
How long have you been aggressively searching for a new position?
(weeks)
How did you hear about us?
Internet (specify to right)
Word of Mouth
Yellow Pages
Newspaper
Referral
Please Specify
Copy and paste a copy of your resume here (or upload the file below):
Upload your resume:
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