Candidate Application

How did you hear of us?

First Name:
Last Name:
Home Phone:
Business Phone:
Cell Phone:
Email Address:
Home Address:
City:
State:
Zip:
Years at Present Address:
Residence
Citizen of U.S.?

Emergency Contact (not spouse):
Address:
City:
State:
Zip:
Telephone:

Spouse Name:
Spouse Occupation:
Spouse Address:
Spouse Telephone:

Do you have a Driver's License?
Would you Commute? Miles?          
Would you Travel?
Would you Relocate? Immediately OR in months
No Relocation? Why?
Day lost to illness in the past 2 years:
Do you have a Resume?

Education-

High School
School Name:
Location:
Dates Attended:
     from:
  to:
Total Years:
Grade Avg.?
Graduate?
College
School Name:
Location:
Dates Attended:
     from:
  to:
Total Years:
Grade Avg.?
Graduate?
Other
School Name:
Location:
Dates Attended:
     from:
  to:
Total Years:
Grade Avg.?
Graduate?
Degrees:
Any Foreign Language?

Position Desired?
Minimum salary for the right opportunity?
When would you be available for interviews?

References-

Reference 1
Name:
Company:
Address:
Phone:
Reference 2
Name:
Company:
Address:
Phone:
Reference 3
Name:
Company:
Address:
Phone:

Work History-

Present or Last Position
Dates Employed-
     from:
  to:
Company Name:
Company Address:
City, state, zip:
Company, Div. Of:
Supervisor Name & Title:
Company Phone:
Supervisor Phone:
Others in same job:
Base Monthly Salary:
     Start$
  Now$
Add'l Monthly Salary:
     Month Avg:
  Bonus:
  Comm.:
Total W-2 Earnings:
$
Last Raise:
     date:
  percentage:
Next Raise:
     date:
  percentage:
What Type of Raise:
Company Car?
Your Title:
Next to Last Position
Dates Employed-
     from:
  to:
Company Name:
Company Address:
City, state, zip:
Company, Div. Of:
Supervisor Name & Title:
Company Phone:
Supervisor Phone:
Others in same job:
Base Monthly Salary:
     Start$
  End$
Add'l Monthly Salary:
     Month Avg.:
  Bonus:
  Comm.:
Total W-2 Earnings:
$
Last Raise:
     date:
  percentage:
Next Raise:
     date:
  percentage:
What Type of Raise:
Company Car?
Your Title:

Work History Continued...

Present or Last Position
Your Major Duty:
Co. Product/Service:
No. of people in dept.
No. people supervised:
2 of Co.'s competitors:
Reason for leaving:
Next to Last Position
Your Major Duty:
Co. Product/Service:
No. of people in dept.
No. people supervised:
2 of Co.'s competitors:
Reason for leaving:
2nd to Last Position
Your Major Duty:
Co. Product/Service:
No. of people in dept.
No. people supervised:
2 of Co.'s competitors:
Reason for leaving:
Nature of Duties (If you have a resume please submit with application, please summarize below-be sure to include achievements)
Present or Last Position
Next to Last Position
2nd to Last Position

 


Grobard & Associates, Inc,
230 Ridge Bluff Lane
Suwanee, Georgia 30024
Phone (770) 271-1828
Fax (770) 271-4026