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Career and Employment Information Form

This form will help determine your qualification for Career Problem Solving Services will be based on the data provide by this Form.  Please answer all questions.

  • Your Name:*

    Address 2:
    Zip Code:
    Telephone #:*
    e-mail address:*
    Are you presently employed? Yes   No
    Education level? High School   College  Graduate School
    College Attended?
    College Degree(s)?
    College Honors?
    Who was your most recent employer?
    Industry (e.g. Banking, Construction, Chemicals, Real Estate, etc.)?
    What was your most recent job title?
    What was your most recent salary?
    What is your present career problem or need:   
    Career advancement?   Yes   No
    Salary improvement?   Yes   No
    Termination protection?   Yes   No
    Termination negotiation?   Yes   No
    Overcome unemployment?   Yes   No
    Career Change?   Yes   No
    New employment contract negotiation?   Yes   No
    Career/Job hunting tool development (resume, cover letter, research)?   Yes   No
    Interview planning, strategizing and preparation?   Yes   No
    Other? Please explain: 
    Please provide any additional information that might help CPSS understand your career needs/priorities:
    * Required

    By clicking on the "Submit" button I acknowledge that I understand that Career Problem Solving Services is not an Employment Agency and that Career Problem Solving Services does not provide Employment Agency Services.



    Career Problem Solving Services is not an employment agency, nor does it provide employment agency services.

    Copyright 1999 E-BMC/Dr. John T. Whiting

    All Rights Reserved.
    Last revised: .

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