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To assist us in matching your qualifications to the needs of our client companies, please complete this questionnaire.

Our client companies assume all of our charges.


Name (First, Last, MI)

Spouses' First Name


City, State   Zip

Home Phone Number: ( Include Area Code)

Email Address:

Bus Phone Number: ( Include Area Code)

Date of Birth:

Height: Weight:  

U.S. Citizen:  yes no

SSN:    Driver's License: 

Marital Status:  Married Single 
# of Children:   Ages:

In Case of Emergency Contact (Not Spouse):    Phone No:

Military Service:  yes  no   Branch:     Final Rank: 

Relocate yes  no  
Travel: yes  no 

Rent Own 

Monthly Payment:  

Value:    Interest %:   Equity:


Select all that apply:

High School Diploma/GED

Trade/ Vocational Year  Graduated:   Major

Undergraduate; Graduated:   Major GPA

Graduate Degree Year Graduated:   Major GPA

Professional Licenses Held: 

Foreign Languages:


Carefully list the titles of two positions you are best qualified for and believe you could fit:

1.    2.  

Present Salary:    Bonus/Incentive:    Minimum Acceptable Salary: 

PROFESSIONAL REFERENCES: (List Person who can attest to your technical or professional competence)

Name (First, Last) Company

Phone No.    Occupation:    City,St: 

Name (First, Last) Company

Phone No.    Occupation:    City,St: 

Name (First, Last) Company

Phone No.    Occupation:    City,St: 

Companies or agencies who now have your applications (past six months)

1.     4. 

2.     5. 

3.     6. 


General job responsibilities/description including number of employees supervised and titles of individuals reporting to you.  Also budget, equipment and material responsibilities, with an indication of whether you influence was direct or indirect. 

Significant accomplishments that relate to sales/profit/cost saving/technical contributions where possible (i.e. elaborate on items such as installed standard cost system, guided development of 3 new products, generated $50,000 in new business, cost cuts by $90,000/yr, etc).

Present/Last Position:

Company:    Position:   

Dates: From To

Supervisor   Ph No: 

St. Salary  End Salary:

Reason for Leaving: 

Most Recent Previous Position Held:

Company:    Position:   

Dates: From To

Supervisor   Ph No: 

St. Salary  End Salary:

Reason for Leaving: 

Other Important Position:

Company:    Position:   

Dates: From To

Supervisor   Ph No: 

St. Salary  End Salary:

Reason for Leaving: 

1.  Geographic Preference: 

2.  I will  consider the following other geographic areas: 

3.  I will not consider the following geographic areas: 

4.  My Reason(s) for seeking employment and my career objective

5.  What are your requirement for a satisfying career? (i.e. responsibilities, lifestyles,etc)

6.  What kind of timetable have you for meeting your career objective?

7.  Are there any upcoming projects,promotions, or vesting dates that would prevent you from a job change within the next 8 weeks?

Y N if yes, please explain 

8.  Date of last salary Increase:  

Amount %

9.  Anticipated date of next salary increase: 

Amount %

10.  My minimum salary requirement is $ /annum recognizing that dnh search will make every effort to obtain the highest salary that the market will bear for my background.

11.  Type of work preferred: 

12.  Type of company preferred: 

13.  Can you be contacted at work? Y N  

If yes, phone# with Area Code and best time to call:

14.  Do not contact the following subsidiaries, divisions, or companies that are too closely related my present employer:

15.  List any specific companies that you would like us to contact on your behalf?

16.  I require  days notice to arrange an interview trip.

17.  Availability, after job acceptance, to be able to report for work with new employer weeks.

18.  How long have you considered making a job change? 

19.  Have you actually made the decision to change jobs, or are you trying to decide whether to stay or leave? 

20.  On a scale of 5 with 1 being the highest, how serious are you about changing jobs?
  1 5

21.  Have you discussed your decision with your family?  Y N  
Does your family approve?  Y N

22.  Is your spouse employed?  Y

Job Title Yearly Earnings? 

23.  Are there personal considerations such as family responsibilities, lifestyles, preferences, or educational commitments which would in anyway limit your mobility or willingness to accept an assignment requiring relocation?  N

  If yes, please explain  

If relocation is necessary, what problems do you anticipate? 

24.  What was it in your past position that made you change to you current (or last) employer?

25.  What is there about your present situation that you would like to change on the next job? 

26.   What type of assignment have you been really good at? 
Has given you the most satisfaction?  Y N

27.  What type activity or assignment, if any, do you feel has given you difficulty? 

28.  Based upon your interests, abilities, and performance what do you see as you major strengths, skills, and talents?(e.g., Planning, Analysis, Inter-personal relationships, technology,.etc)

29.  Have you approached your company about your dissatisfaction?  Y N
Do you intend to?  N

30.  Under what circumstance could your company retain you?

31.  Do you understand the consequences of a buyback?  N

32.  What will it take to overcome the inertia to make the decision to change?

33.  What do you hope that we will be able to do for you?

34.  What has value to you on a job? 

35.  What do you hope to achieve from a career standpoint? (Now, 5yrs, 10 yrs)?

(5 yrs.)

(10 yrs.)

36.  What do you hope to achieve in other areas of your life?

37.  On a scale of 5 with 1 being the highest, how do you personally rate each of the following:






dnh search refers applicants without regard to race, color, religion, sex, age, national origin, mental or physical handicap

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(the following files accepted .doc, .pdf, .txt)

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