Employee Profile Form: Please Print

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
Address
Today's
date
City
State
Zip
Home
phone
Business
phone
Cell
phone
Email
address
Expected
earnings $
Position
applying for
Military
service?
If yes,
which?
Desired
location(s)
If yes,
from:
Hobbies/
interests
If yes,
to:
Bilingual
skills?
Memberships:
Prof. / Social
EDUCATION INFORMATION
High
School
Name of School
Dates Attended
From /
To
College /
University
From /
To
Graduate
School
From /
To
GPA
Graduated?
Degree / Title
Extracurricular
activities
BUSINESS EXPERIENCE
Please begin with your present or most recent position.
1.
Firm
name
Address
City,
State, Zip
Phone
Business
type
Start
date
Final
date
Staff - # of
direct reports
Total
staff
Salary
starting $
Salary
Base
Name of
immediate
supervisor
Title of
immediate
supervisor
What do /
did you like
most about
your job?
Reasons for
leaving or
desiring
change
What do /
did you like
least about
your job?
Major / Subjects
2.
Firm
name
Address
City,
State, Zip
Phone
Business
type
Start
date
Final
date
Staff - # of
direct reports
Total
staff
Salary
starting $
Salary
Base
Name of
immediate
supervisor
Title of
immediate
supervisor
What do /
did you like
most about
your job?
Reasons for
leaving or
desiring
change
What do /
did you like
least about
your job?
3.
Firm
name
Address
City,
State, Zip
Phone
Business
type
Start
date
Final
date
Staff - # of
direct reports
Total
staff
Salary
starting $
Salary
Base
Name of
immediate
supervisor
Title of
immediate
supervisor
What do /
did you like
most about
your job?
Reasons for
leaving or
desiring
change
What do /
did you like
least about
your job?
PREVIOUS POSITIONS HELD
4.
Company
Your
title
Start
date
Reason
for leaving
Name of
supervisor
Compensation
initial:
$
Company
Your
title
Start
date
Reason
for leaving
Name of
supervisor
Compensation
initial:
$
Final
date
Type of
work
Compensation
final:
$
5.
Final
date
Type of
work
Compensation
final:
$
6.
Company
Your
title
Start
date
Reason
for leaving
Name of
supervisor
Compensation
initial:
$
Company
Your
title
Start
date
Reason
for leaving
Name of
supervisor
Compensation
initial:
$
Company
Your
title
Start
date
Reason
for leaving
Name of
supervisor
Compensation
initial:
$
Company
Your
title
Start
date
Reason
for leaving
Name of
supervisor
Compensation
initial:
$
Final
date
Type of
work
Compensation
final:
$
7.
Final
date
Type of
work
Compensation
final:
$
8.
Final
date
Type of
work
Compensation
final:
$
9.
Final
date
Type of
work
Compensation
final:
$
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.
Date
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:
ADDITIONAL CANDIDATE INFORMATION

What qualifications, abilities, and strengths will help you succeed in this job?
1.
2.
3.
4.
5.
What is/are your

greatest strength(s)?
What are your weaknesses and areas needing improvement?
1.
2.
3.
4.
5.
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?
List 5 reasons to hire you rather than someone else:
1.
2.
3.
4.
5.
List 5 adjectives to describe yourself.
1.
2.
3.
4.
5.
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

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EMPLOYEE PROFILE FORM

PREVIOUS POSITIONS HELD

ADDITIONAL CANDIDATE INFORMATION

What is/are your

List 5 reasons to hire you rather than someone else:

Current working days / hours:

201 West Washington Avenue Ste 230 Zeeland, MI 49464

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