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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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