EMPLOYEE PROFILE FORM

Federal 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 PRINT
Last
name

First

Middle

Address

Today's
date

City

State

Zip

Home
phone

Business
phone

Cell
phone

Email
address
Expected
earnings $

Position
applying for

Military
service?

If yes,
which?

Desired
location(s)
If yes,
from:

Hobbies/
interests

If yes,
to:

Bilingual
skills?

Memberships:
Prof. / Social

EDUCATION INFORMATION
High
School

Name of School

Dates Attended

From /
To

College /
University

From /
To

Graduate
School

From /
To

GPA

Graduated?

Degree / Title

Extracurricular
activities
BUSINESS EXPERIENCE
Please begin with your present or most recent position.

1.

Firm
name

Address

City,
State, Zip

Phone

Business
type

Start
date

Final
date

Staff - # of
direct reports

Total
staff

Salary
starting $

Salary
Base

Name of
immediate
supervisor

Title of
immediate
supervisor

What do /
did you like
most about
your job?
Reasons for
leaving or
desiring
change

What do /
did you like
least about
your job?

Major / Subjects

2.
Firm
name

Address

City,
State, Zip

Phone

Business
type

Start
date

Final
date

Staff - # of
direct reports

Total
staff

Salary
starting $

Salary
Base

Name of
immediate
supervisor

Title of
immediate
supervisor

What do /
did you like
most about
your job?
Reasons for
leaving or
desiring
change

What do /
did you like
least about
your job?

3.
Firm
name

Address

City,
State, Zip

Phone

Business
type

Start
date

Final
date

Staff - # of
direct reports

Total
staff

Salary
starting $

Salary
Base

Name of
immediate
supervisor

Title of
immediate
supervisor

What do /
did you like
most about
your job?
Reasons for
leaving or
desiring
change

What do /
did you like
least about
your job?

PREVIOUS POSITIONS HELD

4.

Company

Your
title

Start
date

Reason
for leaving

Name of
supervisor

Compensation
initial:
$

Company

Your
title

Start
date

Reason
for leaving

Name of
supervisor

Compensation
initial:
$

Final
date

Type of
work
Compensation
final:
$

5.
Final
date

Type of
work
Compensation
final:
$

6.
Company

Your
title

Start
date

Reason
for leaving

Name of
supervisor

Compensation
initial:
$

Company

Your
title

Start
date

Reason
for leaving

Name of
supervisor

Compensation
initial:
$

Company

Your
title

Start
date

Reason
for leaving

Name of
supervisor

Compensation
initial:
$

Company

Your
title

Start
date

Reason
for leaving

Name of
supervisor

Compensation
initial:
$

Final
date

Type of
work
Compensation
final:
$

7.
Final
date

Type of
work
Compensation
final:
$

8.
Final
date

Type of
work
Compensation
final:
$

9.
Final
date

Type of
work
Compensation
final:
$

AUTHORIZATION
I, the undersigned candidate for employment, authorize Disher Design & Development to make reference checks which may include employment records, general
reputation, personal characteristics, and finances. I also understand that under the Fair Credit Reporting Act, I have the right to request a copy.

Date

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 authorization
and 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.
If yes, please indicate the nature of the offense, date, court, and deposition:

ADDITIONAL CANDIDATE INFORMATION

What qualifications, abilities, and strengths will help you succeed in this job?

1.
2.
3.
4.
5.

What is/are your

greatest strength(s)?
What are your weaknesses and areas needing improvement?

1.
2.
3.
4.
5.

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?

List 5 reasons to hire you rather than someone else:

1.
2.
3.
4.
5.
List 5 adjectives to describe yourself.

1.
2.
3.
4.
5.
What are your current benefits? Indicate whether you contribute to the cost, and how much?

Current working days / hours:

Interview 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 49464

P: 616.748.6915 F: 616.748.6914 www.disherdesign.com