Network Information Form

Please answer every question as thoroughly as possible.

Providing more detailed information improves your chances for a better match.

How did you find our web site?

Specify Information Here:

Personal Information:

First Name:
Last Name:
Street Address:
City:
State/Province:
Zip Code:
Country:
Home Phone:
Work Phone:
Pager/Cell Phone:
Email Address:

Do you Own or Rent your home?

Education:

Degree:
Major:
GPA:

Please enter a brief description of your strengths, technical skills, intangible skills, or any other relevant info in the space below:

BE THOROUGH -- many of our searches uses KEYWORDS -- so include ALL experience that you have gained.

(Example: I am a highly motivated individual with high mechanical-electrical aptitude; strong CAD design skills; excellent hands-on, troubleshooting skills; excellent interpersonal skills; strong leadership abilities; ........................ )

Languages: (that you speak fairly fluently)

select ALL that apply:

(Use Ctrl-Click to highlight more than one item)

Employment:

Position(s) Seeking:

Which of the following would cause you to consider a position other than the ones you have listed?

Years Experience Applicable to Position that you are seeking:

Current Employer:

Location:

Industry/Prdct Spclty:

Parent Company:

Companies you do not wish to have contacted on your behalf:

What are your reasons for wanting to change employers?

Salary Requirements:

Current Base Compensation:

Overtime or Bonuses:

Benefits or Perks:

Desired Salary with New Position:

Minimum Salary Required of New Position:

Which of the following would cause you to consider a position with a salary lower than the amount you desire?

Are you willing to accept contract employment? YesNo

Are you currently employed? YesNo

If NO, enter the date of termination of your last employment:

If YES, enter the target date for change of employment:

What percentage of your time are you willing to spend travelling as part of the duties of a position?

Preferred Method Of Contact:

Preferred Locations:

(This Map is Provided for State Abbreviation Reference Only)

United States:

(Use Ctrl-Click to highlight more than one item at a time)

Canada:

(Use Ctrl-Click to highlight more than one item at a time)

International:

(Use Ctrl-Click to highlight more than one item at a time)

Please enter any additional relocation information below:

Enter any locations that you are NOT willing to relocate to:

Please enter any Special Requirements you may have (special schooling, spousal employment, etc.):

Which of the following would cause you to consider a position in a different location than the ones you have listed?

I am authorized to work in the USA. YesNo

I am authorized to work in CANADA. YesNo

I have e-mailed my resume as a Microsoft Word or Text attachment to markmiller@netdirect.net

931 East 86th Street, Suite 103	www.millerpersonnel.com	800-851-5938/317-251-5938
Indianapolis, Indiana 46240	markmiller@netdirect.net	Fax: 317-251-5762