1. What is your current title?
   
   
   
2. How long have you held this position?
   Less than 1 year At least 1 year At least 2 years 3 to 5 years More than 5 years
   
   
3. Briefly describe your current responsibilities:
   
   
   
4. Describe the positions) you are looking for:
   
   
   
5. Describe your relevant experience (other than your current position):
   
   
   
6. If you have a minimum salary requirement, enter it here:
   
   
   
7. How long should we keep your information on file?
   3 months 6 months 9 months 1 year indefinitely

We'll need to know how to reach you if something turns up. Enter whatever contact information you feel is most appropriate below:

                        Name 
              Street address 
             Address (cont.) 
                        City 
              State/Province 
             Zip/Postal code 
                     Country 
                  Work Phone 
                  Home Phone 
                         FAX 
                      E-mail 
            

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