Career History Form

Personal Information

Name *

Email *

Home Address

Phone

Referred by

What is your Salary Requirement (Please be Specific)

Why Did You Leave Your Last Job?

What are your career objectives?

What Can You Offer That Another Person Cannot?

What Interests You Most About This Position?

What Attracts You to Working in the Small Business Market?

Please describe the perfect “ next job” for you:

Are You Willing to Work After Hours or on Weekends?

Do You Live in the Greater New Orleans Area or are You Willing to Re-locate to the Greater New Orleans Area?

Yes No

When Would You be Available?

Is There Anything Else You Feel is Important to Mention Now?

Employment History

Most Recent Employment Position:

Firm Name

Firm's Address

Firm's City

Firm's State

Firm's Zip

Firm's Phone Number

Kind of Business

Start Date

Final Date

Title

Staff: Number of Direct Reports

Total Staff

Starting Salary

Base

Bonus

Final Salary

Base

Bonus

Was your employment at this company

Full-time Part-time

Name of Immediate Supervisor

Title of Immediate Supervisor

If rating is 'Impossible to Provide', please explain

What do (did) you like most about your job?

What do (did) you least enjoy?

What were some of your reasons for accepting this position?

Motivation to Leave Company

100% Mine Mutual 100% Company's Options Don't Fit Circumstance

If 'Options Don't Fit Circumstance', please explain

May we contact this employer?

Yes No

2nd Most Recent Employment Position:

Firm Name

Firm's Address

Firm's City

Firm's State

Firm's Zip

Firm's Phone Number

Kind of Business

Start Date

Final Date

Title

Staff: Number of Direct Reports

Total Staff

Starting Salary

Base

Bonus

Final Salary

Base

Bonus

Was your employment at this company

Full-time Part-time

Name of Immediate Supervisor

Title of Immediate Supervisor

If rating is 'Impossible to Provide', please explain

What do (did) you like most about your job?

What do (did) you least enjoy?

What were some of your reasons for accepting this position?

Motivation to Leave Company

100% Mine Mutual 100% Company's Options Don't Fit Circumstance

If 'Options Don't Fit Circumstance', please explain

May we contact this employer?

Yes No

3rd Most Recent Employment Position:

Firm Name

Firm's Address

Firm's City

Firm's State

Firm's Zip

Firm's Phone Number

Kind of Business

Start Date

Final Date

Title

Staff: Number of Direct Reports

Total Staff

Starting Salary

Base

Bonus

Final Salary

Base

Bonus

Was your employment at this company

Full-time Part-time

Name of Immediate Supervisor

Title of Immediate Supervisor

If rating is 'Impossible to Provide', please explain

What do (did) you like most about your job?

What do (did) you least enjoy?

What were some of your reasons for accepting this position?

Motivation to Leave Company

100% Mine Mutual 100% Company's Options Don't Fit Circumstance

If 'Options Don't Fit Circumstance', please explain

May we contact this employer?

Yes No

Military Experience

Have you been or are you in the military?

Yes No

Education

High School Information:

High School

Did you earn a high school diploma or GED?

Approximate Graduating Class Size:

Rank from the top:

Final GPA:

GPA scale:

Extracurricular Activities:

Positions of Responsibility, Honors and Awards:

Multi-line Text

Part-Time and Summer Work:

University/Post Graduate School Information:

College/University/Post Graduate School Years Completed:

College/University Attended:

Dates Attended:

Degree:

Subject/Major:

Qualification/GPA:

Total credit hours:

Extracurricular activities, honors and awards:

What undergraduate subjects did you like the most? Why?

What undergraduate subjects did you like the least? Why?

How was your education financed?

Part-Time and Summer Work:

Other Courses, Seminars or Studies:

Qualifications

Please list membership in professional or job-relevant organizations. You may exclude groups that indicate race, color, religion, national origin, disability or other protected status.

Please list publications, patents, inventions, professional licenses or additional special honors or awards:

What qualifications, abilities and strong points will help you succeed in this job?

What are your weak points and area for improvement?

Please indicate what you think the average rating would be by all of the managers you've has in the past 5 years, on:

Do you have the legal right to work for any employer in the country in which you currently reside?

Yes No

Just prior to a job offer would you be willing to arrange personal reference calls with managers (and others) you have worked with in the past?

Yes No

As Seen On:

Career History Form