disheremployeeprofile.pdf
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Address
Phone
Total
staff
Final
date
Start
date
Staff - # of
direct reports
Title of
immediate
supervisor
What do /
did you like
leastabout
your job?
Reasons for
eaving or
desiring
hange
What do /
did you like
mostabout
your job?
Salary
Base $
Name of
mmediate
upervisor
alary
tarting $
Business
ype
City,
tate, Zip
Firm
name
.
BUSINESS EXPERIENCE
Please begin with your present or most recent position.
EDUCATION INFORMATION
Name of School Dates Attended GPA Graduated? Degree / Title Major / SubjectsFrom /
To
From /
To
From /
To
High
chool
College /
University
Graduate
chool
Extracurricular
ctivities
EMPLOYEE PROFILE FORMFederal 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 PRINTLast
name
First Middle
Today'sdateAddress
City State Zip
Cell
phone
Business
phone
Home
phone
Email
ddress
Expected
earnings $
Position
applying for
Desired
location(s)
Bilingual
skills?
If yes,
to:
If yes,
from:
If yes,
which?
Military
ervice?
Memberships:
Prof. / Social
Hobbies/
nterests
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2.
Reasons for
eaving or
desiring
hange
What do /
did you like
leastabout
your job?
Title ofimmediate
supervisor
What do /
did you like
mostabout
your job?
Name ofmmediate
upervisor
alary
tarting $
Salary
Base $
Staff - # of
direct reports
Total
staff
Final
date
Start
date
Business
ype
PhoneCity,
tate, Zip
AddressFirm
name
3.
Phone
AddressFirm
name
City,
tate, Zip
Business
ype
Start
date
Final
date
Total
staff
Staff - # of
direct reports
Salary
Base $
alary
tarting $
Name of
mmediate
upervisor
Title of
immediate
supervisor
What do /
did you like
leastaboutyour job?
What do /
did you like
mostaboutyour job?
Reasons for
eaving or
desiring
hange
4.PREVIOUS POSITIONS HELD
Compensation
final:$
Compensation
initial:$
Name of
supervisor
Reason
or 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
or leaving
Company
5.
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6.
Compensation
final:
$
Type of
work
Final
date
Compensation
initial:
$
Start
date
Name of
supervisor
Your
title
Reason
or leaving
Company
Compensation
final:
$
Type of
work
Final
date
Compensation
initial:
$
Start
date
Name of
supervisor
Your
title
Reason
or leaving
Company
7.
Compensation
final:
$
Type of
work
Final
date
Compensation
initial:
$
Start
date
Name of
supervisor
Your
title
Reason
or leaving
Company
8.
Compensation
final:
$
Type of
work
Final
date
Compensation
initial:
$
Start
date
Name of
supervisor
Reason
or leaving
9.
Your
title
Company
DateX
AUTHORIZATION
the undersigned candidate for employment, authorize Disher Design & Development to make reference checks which may include employment records, general
eputation, 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 authorizat
nd 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.
f yes, please indicate the nature of the offense, date, court, and deposition:
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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:
nterview 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 494
P: 616.748.6915 F: 616.748.6914 www.disherdesign.co