"Committed to excellence in pharmaceutical, medical device, and biotechnology search and recruiting"

APPLICANT QUESTIONNAIRE
(RETURN WITH YOUR RESUME)
This is not a Contract - No Signature Required
 All Referrals are on an Employer Fee Paid Basis.

PLEASE BE COMPLETE

I. PERSONAL

Name Home Phone
Address Work Phone
City, State Cell Phone
Zip Own Home
Rent Home		 Pager
E-Mail
Spouse's Name
Spouse's Occupation Spouse's Work #
 
Name, address and phone of someone, other than your spouse, who can always contact you.

II. EMPLOYMENT INFORMATION

Are you employed? NO YES Reason for change
If no, why and last day worked
When available for interviews?
When available to start work?
Employer: Present
Last		 Title
Division of: Products/ Services

III. SALARY INFORMATION

Base Salary: Present
Last		 Bonus?
Desired Salary $ Minimum Acceptable $
Date of next scheduled salary review
These are simply guidelines. We understand that location, C.O.L., opportunity for career growth and many other factors will influence the above.

IV. EDUCATION

Degree Major GPA
College/Univ. Date
Grad. Degree Major GPA
College/Univ. Date
Other

V. JOB SEARCH PARAMETERS

Type of position sought (describe or title)
Relocation/Geographic Preferences (describe)

VI. GENERAL

So that we do not duplicate your efforts, please list companies and agencies whom you have contacted, with results thereof

US Citizen: Yes
No		 Residence/Visa status

We are occasionally requested by some employers to make reference checks. We do so only at their request and with your permission. May we have two references (one supervisor and one co-worker) from each of your last two employers. Include your present employer only if we have permission to check with the person listed.

Employer: Present
Last
Supervisor (name, title and phone #)
Supervisor EMail Address
Co-worker (name, title and phone #)
Co-worker EMail Address
Next Previous Employer
Supervisor (name, title and phone #)
Supervisor EMail Address
Co-worker (name, title and phone #)
Co-worker EMail Address
How did you learn of our Company?
Would any of your friends or co-workers be interested in our services? Yes
No
If so, may we have their name, titles, phone # and EMail address

R E S U M E
If you have a current resume in electronic format, you can forward a copy to us in one of the following ways.

Either cut and paste a plain text copy in the entry box below (the resume will be sent along with the rest of the questionnaire)

OR start the email function of your Web browser by clicking the name of the person to whom you would like to send the resume (shown below) and ATTACH a copy of your resume in either Word or WordPerfect format.
     Lee Douglas    
Phil Ellis       
NOTE: If you email your resume to us by clicking one of the names listed above, you will still need to press the "Submit Questionnaire" button below to send us the content of the questionnaire. Please send the questionnaire to the same person who will receive your resume.

VII. DESTINATION

Which individual within Phil Ellis Associates, Inc. should receive this questionnaire?

    Phil Ellis    
Lee Douglas    

. . .