Please provide the following candidate contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
Work EMail
Home Email
URL

Contact person, not your spouse or person residing with you, who can always contact you and their relationship:

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

Are you authorized to work in the US?	Yes      No
Are you currently employed?	Yes     No

If not employed: Why and last day worked

         When available for interviews and when can you start work?

 Employers: Present company & Title; Previous company & Title; Products / Services

 Salary Information: Base; Previous; Bonuses; Next salary review?

          Desired Base Salary and Minimum Acceptable?

 Education: Highest degree; Major; date; Colleges and Universities attended:

 Job Search Preferences: Type of position sought or title.

 Relocation:  

           Preferred Relocation/Geographic locations:

.

 Skills: (Please list your strongest skills. Be specific eq: Immunoassay development, HPLC, MALDI, etc.)

         Please list companies and agencies you have contacted and the results thereof:

Please give us your permission to speak with other recruiters on your behalf.  We do not allow your credentials to be presented to any potential employer without your explicit permission.

Yes    No

Jim Smith
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Revised: 01/25/10