First name:
Last name:
Address:
City:
State:
Zipcode:
Telephone:
Cell phone:
Email address:


Following are questions regarding your past, current and future education and employment opportunities. You are not required to answer the questions, but doing so will assist us in providing you further guidance regarding your career choices.

Are you currently a student?
Yes
No

If yes, please check level of school you are currently attending:
High School
Trade/Vocational School
Junior/Community College
College/University

If attending High School and you desire further education, please indicate the level of education you desire to achieve:
Trade/Vocational School
Junior/Community College
College/University

If attending High School and desire further education, what is your desired field of study?


If attending High School and desire further education, do you have the funding you need to pursue your educational goals?
Yes
No

If no, are you interested in exploring potential funding opportunities?
Yes
No

If you are not currently a student, please indicate highest level of school completed:
Junior High School
High School
Trade/Vocational School
Junior/Community College
College/University

If a graduate of a college or university, please list major or primary area of study:


If a graduate of a college or university, please indicate degree earned:
Bachelors
Masters
Ph.D, J.D. or other Doctorate
Other:   Please Specify:  


Please list any other education or training you have received:


Are you currently employed?
Yes
No

If no, are you interested in seeking employment?
Yes
No

If yes, is work full time or part time?
Full time Part time

If full time, is this your career of choice?
Yes
No

If no, are you interested in a career change? Yes
No

If yes, what career are you most interested in pursuing?


Are you willing to enroll in training/continuing education courses required for your desired career?
Yes
No

If yes, do you have the funding you need to pursue the training/education you need? Yes
No

If no, are you interested in exploring potential funding opportunities? Yes
No


EDUCATION
Education Type of School
Name and Address of School
Major Subject
Graduated
Degree Received
High School
Yes No
College
Yes No
Graduate School
Yes No
Other
Yes No
Please describe skills and training, including computer skills and any relevant military training, you feel qualify you for the position for which you are applying.
PREVIOUS EMPLOYMENT - begin with current/most recent job
I have no previous employment experience.
1 EMPLOYER
Name of Company:
 Job Title:
 Job Duties:
 Reason for Leaving:
Address:
Supervisor Name:
 Starting Dates:
 Ending Dates:
Phone No.
 Type of Business:
 Starting Salary:
 Ending Salary:
May we contact employer? Yes   No
I have no other employment experience (employer 2).
2 EMPLOYER
Name of Company:
 Job Title:
 Job Duties:
 Reason for Leaving:
Address:
 Supervisor Name:
 Starting Dates:
 Ending Dates:
Phone No.
 Type of Business:
 Starting Salary:
 Ending Salary:
May we contact employer? Yes   No
I have no other employment experience (employer 3).
3 EMPLOYER
Name of Company:
 Job Title:
 Job Duties:
 Reason for Leaving:
Address:
 Supervisor Name:
 Starting Dates:
 Ending Dates:
Phone No.
 Type of Business:
 Starting Salary:
 Ending Salary:
May we contact employer? Yes   No


Please check the box on the left if you would like to receive our career newsletter or be advised about future career opportunities with clients of CRI at no cost or obligation to you.