The Human Resource Connection

	*Registration Form*
Instructions: Red denotes required fields. Please type "none" in fields that are not applicable to you. * To select two or more options, hold down control key while clicking mouse.
	*Contact Information*
Name:	last first maiden if used professionally
Address:	street city state zip
Phone:	work cell home
Email:	personal professional
May we contact you at work?
	*Professional Credentials and Experience*
Education:
Majors:	Undergraduate:
	Post Graduate:
Certifications:
Additional Training:
Summary of Professional Experience and capabilities:
	*Compensation*
Current/last:	Base: $ Bonus: % or $ Stock Options:
Desired Base:
Min. Acceptable:
	*Future Employment Interest*
Positions of Interest:*
	Other:
Preferred Responsibilities: (describe)
Industries of Interest:*	Other:
Size Company:*	(# of employees)
Desired Culture/ Environment: (describe)
Company Management Style:*
Company Life Cycle:*
Location:*	Other: (specify)
Relocation:
Maximum acceptable commute (specify):
Employment Status:

I AGREE THIS IS TRUE AND ACCURATE REPRESENTATION OF MY EDUCATION AND PROFESSIONAL EXPERIENCE, and I understand that The Human Resource Connection and its representatives may verify the information contained in this document and the attached resume. I AGREE I DISAGREE

All information provided to The Human Resource Connection will be kept confidential and used for no other purpose than those described here. If at any time, you have questions about our services or the registration process, please email us or call us at 203.495.1515.