PROFILE FORM
H/R SEARCH, INC
Chicago’s Premier Placement & Consulting Firm
35 E. Wacker Drive, Suite 1052
Chicago, Illinois 60601
Telephone: (312) 658-1400 Fax: (312) 658-1408
www. hrsearchinc.com
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
City
State
Zip Code
Home Phone
( ) -
Business Phone
( ) -
Cell Phone
( ) -
E-mail Address_______________________________________ Social Security #:_________-_________-____________
Previous Address / City, State ZIP
Emergency Contact (not spouse) / Phone
Own home
Board How Long?
Rent # yrs. in community
Spouse’s Name
Spouse’s Occupation & Name of Company
Will Relocate: Y __ N __ Immediately? Y __ N __ If not, when?
Will Travel: Y __ N __
Circle One:
Limited / Extensive
Location(s) Desired:
Military: Branch of Service: From: To:
/ /
Bilingual Skills?
Hobbies/ Outside Interests
Memberships: Professional/Social
Education Information
Name of School
Dates Attended
From / To
GPA Graduated? Degree / Title
Major / Subjects
H.S.
/
Yes
No
College or University
/
Yes
No
Other
/
Yes
No
Position Desired (In Order of Importance)
A. B. C.
Have Resume Y __ N __
Personal References
Please list three individuals who have knowledge of your personal abilities and character.
(No Former Employers or Relatives)
Name
Title
Known how
long?
Home Phone
Work Phone
Other names by which you are known to personal or employment ref