Complete the following to provide your screener with a preliminary preview of your qualifications.

What is your Phone # where you can be reached? xxxxxxxxxx no hyphens area code and number

What type of business best describe your current/last position: Please Select Accounting/Auditing Administrative and Support Services Advertising/Marketing/Public Relations Agriculture, Forestry, & Fishing Architectural Services Arts, Entertainment, and Media Banking Biotechnology and Pharmaceutical Community, Social Services, and Nonprofit Computers, Hardware Computers, Software Construction, Mining and Trades Consulting Services Customer Service and Call Center Education, Training, and Library Employment Placement Agencies Engineering Finance/Economics Financial Services Government and Policy Healthcare, Other Healthcare, Practitioner and Technician Hospitality/Tourism Human Resources Information Technology Installation, Maintenance, and Repair Insurance Internet/E-Commerce Law Enforcement, and Security Legal Manufacturing and Production Military Other Personal Care and Service Real Estate Restaurant and Food Service Retail/Wholesale Sales Science Sports and Recreation Telecommunications Transportation and Warehousing

Years of work experience: Please Select 1-5 Years 6-10 Years 11-15 Years 16-20 Years 20+ Years

Are you currently employed? Yes No

Your current/last annual income: Please Select Less than $35,000 $35,000 - $45,000 $45,000 - $55,000 $55,000 - $65,000 $65,000 - $75,000 $75,000 - $85,000 $85,000 - $100,000 $100,000 - $150,000 More than $150,000

How many years of education have you completed? Please Select No HS Diploma School of Hard Knocks Vocational/Technical Training High School Diploma/GED Associate Degree/Certificate (approx. 2 years) Bachelor's Degree (approx. 4 years) Master's Degree (Bachelors + approx. 2 years) Doctorate Degree (Masters + 2-4 years)

First Name: Last Name:

Address: City:

State: Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:

Home Phone Number:

Email Address:

Additional Information: