First Name:
Last Name:
Address:
City:
Zip Code:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Daytime Phone:
Evening Phone:
Cellphone:
Email:
Where will you relocate to?:
What areas (locations) are not of interest?:
Do you own a home?:
If yes, how long do you estimate it will take to sell with present market?:
Why are you looking for a new position?:
Is your Search confidential?:
Is your resume posted on any of the job boards? If so, which ones ?:
When was your last day worked, if applicable?:
It is very important for us to be prepared to explain your employment changes up-front to our clients. Please list your previous employers, including a brief explanation for making a change (Example: ABC Corp – Downsized; XYZ Company – Recruited for a career move; etc.):
What products and processes have your current and previous firms manufactured? Give a brief description:
What types of positions will interest you?:
What are your greatest professional strengths?:
Please describe your current company (sales, products, number of personnel):
What is your current base salary? Any Bonus or Overtime?:
What salary range would interest you?:
How much travel would you do?:
Are there any personal situations that impact relocation (such as spousal career, education needs, etc.)?:
Are you currently eligible to work in the United States?:
Do you have a Visa?:
Option – Name and Position of 3 peers with whom you currently work with or have in the past.:
