1. Address
Phone
Total
staff
Final
date
Start
date
Staff - # of
direct reports
Title of
immediate
supervisor
What do /
did you like
least about
your job?
Reasons for
leaving or
desiring
change
What do /
did you like
most about
your job?
Salary
Base $
Name of
immediate
supervisor
Salary
starting $
Business
type
City,
State, Zip
Firm
name
1.
BUSINESS EXPERIENCE
Please begin with your present or most recent position.
EDUCATION INFORMATION
Name of School Dates Attended GPA Graduated? Degree / Title Major / Subjects
From /
To
From /
To
From /
To
High
School
College /
University
Graduate
School
Extracurricular
activities
EMPLOYEE PROFILE FORM
Federal law prohibits discrimination based on age, race, religion, sex, or national origin. Information given through your profile cannot and will not be used for any
discriminatory purpose.
PLEASE PRINT
Last
name
First Middle
Today's
date
Address
City State Zip
Cell
phone
Business
phone
Home
phone
Email
address
Expected
earnings $
Position
applying for
Desired
location(s)
Bilingual
skills?
If yes,
to:
If yes,
from:
If yes,
which?
Military
service?
Memberships:
Prof. / Social
Hobbies/
interests
2. 2.
Reasons for
leaving or
desiring
change
What do /
did you like
least about
your job?
Title of
immediate
supervisor
What do /
did you like
most about
your job?
Name of
immediate
supervisor
Salary
starting $
Salary
Base $
Staff - # of
direct reports
Total
staff
Final
date
Start
date
Business
type
PhoneCity,
State, Zip
AddressFirm
name
3.
Phone
AddressFirm
name
City,
State, Zip
Business
type
Start
date
Final
date
Total
staff
Staff - # of
direct reports
Salary
Base $
Salary
starting $
Name of
immediate
supervisor
Title of
immediate
supervisor
What do /
did you like
least about
your job?
What do /
did you like
most about
your job?
Reasons for
leaving or
desiring
change
4.
PREVIOUS POSITIONS HELD
Compensation
final:
$
Compensation
initial:
$
Name of
supervisor
Reason
for leaving
Type of
work
Final
date
Start
date
Your
title
Company
Compensation
final:
$
Type of
work
Final
date
Compensation
initial:
$
Start
date
Name of
supervisor
Your
title
Reason
for leaving
Company
5.
3. 6.
Compensation
final:
$
Type of
work
Final
date
Compensation
initial:
$
Start
date
Name of
supervisor
Your
title
Reason
for leaving
Company
Compensation
final:
$
Type of
work
Final
date
Compensation
initial:
$
Start
date
Name of
supervisor
Your
title
Reason
for leaving
Company
7.
Compensation
final:
$
Type of
work
Final
date
Compensation
initial:
$
Start
date
Name of
supervisor
Your
title
Reason
for leaving
Company
8.
Compensation
final:
$
Type of
work
Final
date
Compensation
initial:
$
Start
date
Name of
supervisor
Reason
for leaving
9.
Your
title
Company
DateX
AUTHORIZATION
I, the undersigned candidate for employment, authorize Disher Design & Development to make reference checks which may include employment records, general
reputation, personal characteristics, and finances. I also understand that under the Fair Credit Reporting Act, I have the right to request a copy.
VISA INFORMATION
Can you provide evidence that you are legally able to work in the United States?
Please note that as required by the Immigration Reform and Control Act of 1986, you cannot be employed unless you can produce work authorization
and identity documents as specified by the law. If you cannot provide proper documentation, you should discuss this with your recruiter immediately.
CRIMINAL INFORMATION
Within the past seven years have you been convicted of an offense against civil or military law, or been released from a prison or other detention facility?
(Omit [1] traffic violations with a fine under $100 except where liquor or drugs were involved and [2] any offense committed before your 21st birthday
which was finally adjudicated in a juvenile court or under a youth offender law.) A conviction record will not necessarily bar you from employment.
If yes, please indicate the nature of the offense, date, court, and deposition:
4. What is/are your
greatest strength(s)?
5.
4.
3.
2.
1.
What qualifications, abilities, and strengths will help you succeed in this job?
ADDITIONAL CANDIDATE INFORMATION
5.
4.
3.
2.
1.
What are your weaknesses and areas needing improvement?
5.
4.
3.
2.
1.
List 5 reasons to hire you rather than someone else:
What is the primary reason you have accepted positions in the past? Is it something that must be offered by a new company in order to motivate you to
make a career change?
5.
4.
3.
2.
1.
List 5 adjectives to describe yourself.
What are your current benefits? Indicate whether you contribute to the cost, and how much?
Current working days / hours:
Interview availability days / hours:
Do you plan to give your current
employer 2 weeks notice?
Are you willing to do contract
work as a consultant?
Minimum hourly rate you will
consider?
Minimum length of assignment you
will consider?
201 West Washington Avenue Ste 230 Zeeland, MI 49464
P: 616.748.6915 F: 616.748.6914 www.disherdesign.com
