Primary Areas of Interest (check all that apply)

Communication Skills     Customer Service     Management Skills

Leadership     Lifestyle Management     Mentoring 

Education   Some High School High School Graduate Some College College Graduate Post Graduate Work

Work Experience (check all that apply)

Clerical     Operations     Administration

Sales     Accounting     Engineering

Supervisory Experience  None Less Than 5 Years 5 - 10 Years Over 10 Years

Management Techniques You Have Worked With

Management by Objectives      Total Quality Management  

Other   

Organizational Tools You Use

Paper Calendar     Computer Based Calendar     Cell Phone  

Paper Organizer (Day-Timer, etc)     PDA (Palm/Pocket PC)  

Other   

Professional Organizations (name, years a member, officer or committees)

Other Organizations (name, years a member, officer or committees)

Describe a typical week day (include commute times)

Describe a typical weekend

How Do You Learn Best       Hands-On Visual Written Verbal

When Do You Learn Best     Morning Afternoon Evening

Do you have a resume? Yes No  Is Your Resume current? Yes No

What Are Your Hobbies

List The Last 5 Books You Have Read

List 5 Things In Your Personal Life You Would Like to Reorganize

The Most Convenient Time For Us To Phone You To Discuss Your Needs

Day of Week:    Monday Tuesday Wenesday Thursday Friday Saturday

Time of Day:  Between  8 9 10 11 12 1 2 3 4 5 6 7 am pm    and   1 2 3 4 5 6 7 8 9 10 11 12 pm am

Home or Work:  Home Work

Any Other Information You Would Like Us To Know

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