Last Name:
First Name:
Middle Name:
Address:
City:
State:
Zip Code:
Home Phone:
Business Phone:
Cell Phone:
Email Address:
Social Security #:
Previous Address / City, State, ZIP
Emergency Contact (not Spouse) / Phone
How long?
Spouse's Name:
Spouse's Occupation & Name of Company:
Will Travel:
Will Relocate:
Immediately?:
If not, when?
Check One:
Location(s) Desired:
Military: Branch of Service:
From:
To:
Bilingual Skills:
Hobbies / Outside Interests:
Membership: Professional/Social
Education Information Dates Attended
GPA
Graduate
Degree/Title
Major/Subjects
Name of School
From:
To:
High School
College or University
Other
Position Desired (In Order of Importance): A.
B.
C.
Have Resume?
Personal References Please list three individuals who have knowledge of your personal abilities and charactre.
Name
Title
Know How Long?
Home Phone
Work Phone
Other names by which you are know to personal or employment references you have listed
(if different from present): Authorization: I, the undersigned candidate for employment, authorizes H/R Search, Inc. to assist me in
securing employment and to make reference checks which may include employment records, general reputation,
personal characteristics, and finances. I also understand that under the Fair Credit Reporting Act, I
have the right to request a copy.
X
Date:
VISA INFORMATION Can you provide evidence that you are legally able to work in the United States?
Please note that as required by the immigration reform and control act of 1986, you cannot
be employed unless you can produce work authorization and identity documents as specified by the law. If
you cannot provide proper documentation, you should discuss this with your recruiter immediately. CRIMINAL RECORD Within the past 7 years have you been convicted of an offense against civil or military law,
or been released from a prison or other detention facility? (Omit [1] traffic violations with a fine under
$100 except where liquor or drugs were involved and [2] any offense committed before your 21st birthday which
was finally adjudicated in a juvenile court or under a youth offender law) A conviction record will not
necessarily bar you from employment.
If yes, please indicate the nature or the offense, date, court and deposition: REFERRAL SOURCE (How did you hear about us?)
Name:
Name:
Name:
Name:
EMPLOYMENT HISTORY: PLEASE LIST BELOW ALL OF YOUR FORMER
EMPLOYERS BEGINNING WITH THE MOST RECENT
From
To
Name and Location of
Month/Yr.
Month/Yr.
Organization
Nature of Business
Position/Title
EMPLOYMENT HISTORY CONTINUED
Starting
Final
Name and Business
Duties Performed
Salary
Salary
Reason for Leaving
Phone# of Immediate Supv
Do you have any commitments to another employer (past or present) that might affect your
employment?
In the past two years how many scheduled days of work have you missed? (not vacation)
Is this typical for you?
Does your present employer know you are considering leaving?
Are there any employers who might not rehire you?
If yes, please explain: ADDITIONAL CANDIDATE INFORMATION
List five major accomplishments: List five things you'd change at your current job:
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
What is/are your greatest strength(s)?
List area(s) you'd like to improve upon:
What is the primary reason you've accepted positions in the past, and is something that must
be offered by a new company to motivate you to make a career change?
List five reasons to hire you over someone else: List five adjectives to describe yourself:
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
What are your current benefits? (Indicate whether you contribute to the cost and how much)
Please list your current salary and your desired salary:
Current:
Desired:
(Base - excludes bonuses and value of benefits)
$
$
Explain briefly the ways you will be of greatest value to your next employer:
Explain briefly your educational goals for the next five years:
Current working days / hours:
Interview availability days / hours:
Do you plan to give your current employer two weeks notice?
Are you willing to do temporary, temp to hire, or contract work?
Are you registered with any other recruiting firms?
If Yes, who?
Minimum hourly rate you will consider? ($/hr)
Minimum length of assignment you will consider?
Please list five companies you would like to work for: Please list any companies you would not want to work for:
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.