Career History Form

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Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Referred By

What is your salary requirement (please be specific)?(Required)

Why did you leave your last job? Refer to your most recent previous employer if still currently employed.(Required)

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 the Small & Medium Business Market?

Please describe the perfect next job for you.

Are you willing to work after hours or weekends?

Yes

Do you live within 50 miles of Murray, KY or are you willing to relocate to the Murray, KY area if the position requires it?(Required)

Yes

When would you be available?

Is there anything else you feel is important to mention now?

Current/Previous Employer

Business Name

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Business Phone Number

Type of Business

Start Date (mm/yy)

Final Date (mm/yy)

Title

Number of Direct Reports

Total Staff Count (approx.)

Starting Salary

Final Salary

Were you Full-Time or Part-Time?

Full-Time

Part-Time

Name of Immediate Supervisor

Title of Immediate Supervisor

Describe how you believe this supervisor would rate your overall performance.

If this rating is "impossible to provide", please explain.

What do/did you like most about this job?

What do/did you least enjoy about this job?

What were some of your reasons for accepting this job?

What was your motivation for leaving or considering leaving this job?

May we contact this employer?

Yes

Previous Employer

Business Name

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Business Phone Number

Type of Business

Start Date (mm/yy)

Final Date (mm/yy)

Title

Number of Direct Reports

Total Staff Count (approx.)

Starting Salary

Final Salary

Were you Full-Time or Part-Time?

Full-Time

Part-Time

Name of Immediate Supervisor

Title of Immediate Supervisor

Describe how you believe this supervisor would rate your overall performance.

If this rating is

What do/did you like most about this job?

What do/did you least enjoy about this job?

What were some of your reasons for accepting this job?

What was your motivation for leaving or considering leaving this job?

May we contact this employer?

Yes

Previous Employer

Business Name

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Business Phone Number

Type of Business

Start Date (mm/yy)

Final Date (mm/yy)

Title

Number of Direct Reports

Total Staff Count (approx.)

Starting Salary

Final Salary

Were you Full-Time or Part-Time?

Full-Time

Part-Time

Name of Immediate Supervisor

Title of Immediate Supervisor

Describe how you believe this supervisor would rate your overall performance.

If this rating is

What do/did you like most about this job?

What do/did you least enjoy about this job?

What were some of your reasons for accepting this job?

What was your motivation for leaving or considering leaving this job?

May we contact this employer?

Yes

Previous Employer

Business Name

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Business Phone Number

Type of Business

Start Date (mm/yy)

Final Date (mm/yy)

Title

Number of Direct Reports

Total Staff Count (approx.)

Starting Salary

Final Salary

Were you Full-Time or Part-Time?

Full-Time

Part-Time

Name of Immediate Supervisor

Title of Immediate Supervisor

Describe how you believe this supervisor would rate your overall performance.

If this rating is

What do/did you like most about this job?

What do/did you least enjoy about this job?

What were some of your reasons for accepting this job?

What was your motivation for leaving or considering leaving this job?

May we contact this employer?

Yes

Have you ever been in the military?

Yes

High School

Did you earn a high school diploma or GED?

Yes

College, University, Post-Graduate school years completed

College/University Attended

Dates Attended

Degree

Major

GPA

Total Credit Hours (if not completed)

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/Summer work experience

Other courses, seminars or studies

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

Please list publications, inventions, patents, professional licenses, certifications 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 areas for improvement?

Judgment/Decision Making(Required)

Amazing

Great

Typical

Lacking

Terrible

Drive/Energy(Required)

Amazing

Great

Typical

Lacking

Terrible

Resourcefulness/Initiative(Required)

Amazing

Great

Typical

Lacking

Terrible

Team Player(Required)

Amazing

Great

Typical

Lacking

Terrible

Likability(Required)

Amazing

Great

Typical

Lacking

Terrible

Leadership(Required)

Amazing

Great

Typical

Lacking

Terrible

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

Yes

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

Yes

Current/Previous Employer

Previous Employer

Previous Employer

Previous Employer

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