By filling out this online form you will provide us with the necessary initial information to begin our assessment process. It is important that you answer all questions honestly.

NOTE: All information provided is held in the strictest of confidence, see our privacy policy. All fields must be filled out in order to submit this form.

Please complete the form below:
 

Your Current Situation: What best describes your job situation?
Limited Advancement Opportunities with Current Employer Unemployed with no progress in search Recently sold business Job in jeopardy due to recent changes Senior Executive, uneasy about the future Too long at the same place Too many jobs, not enough successes Educator, ready for career change Ready to leave the military or government Middle Aged "Consultant," would rather have the security of a "real job" Haven't found yourself? Choose this.
Contact Information:
Name		Address
Email		City, State Zip
Home Phone		Cell Phone
Professional Information:
Confidential? yes no  The information you provide us will be kept in strict confidence.
Title best describing your current/last position:		Are you currently employed?
Accountant/CPA Administrative/Secretarial Analyst Attorney CEO CFO CIO Consultant Director Doctor/MD/PhD Educator Engineer/Technician Manager Network Manager Office Manager President/Owner/Partner/Chairman Programmer/Developer Project Manager Purchaser/Buyer Sales Representative Scientist Specialist Staff Position Student Supervisor System Administrator Treasurer/Controller/Comptroller Vice President Webmaster Other		yes no
Education:		If not, how long have you been unemployed?
BA/BS Masters Ph.D J.D./LLD Military Some College No College		Select Less than 15 days 15-30 days 30-45 days 45-60 days Longer than 60 days
Current Income:	Desired Income:	Years of work experience:
Select 30-40 40-50 50-60 60-70 70-80 80-90 90-100 100-115 115-130 130+	Select 30-40 40-50 50-60 60-70 70-80 80-90 90-100 100-115 155-130 130+	Select 1-5 6-10 11-15 16-20 21-25 26+
Additional Information: (To expedite your assessment, copy and paste an MS Word or Text Format Resume in the space to the right. We will contact you shortly.)
How did you hear about us? Internet Word of Mouth Yellow Pages Newspaper Referral

Have you had any interviews that excited you in the last 30 days?  yes    no

If so, have you scheduled a follow up interview?   yes    no    not sure
Date Scheduled:

Do you have credible job offers pending?   yes    no

If so, what is the current status of this offer?
Select Accepted, but still looking Rejected Evaluating Offer

How long have you been aggressively searching for a new position?  (weeks)

THIS IS NOT AN OFFER OF EMPLOYMENT

Privacy Policy
Berkeley Palmer is committed to protecting your privacy. The only reason we request information about you is to provide you with a more personalized on-line experience.

Use of Information:

• Berkeley Palmer will not reveal any personal information that users provide to us to any third party without their permission.
• Upon request, Berkeley Palmer will remove users (and their information) from our database.

General
Berkeley Palmer uses reasonable precautions to keep the personal information disclosed to us secure. We will only disclose such information to responsible third parties after receiving permission from the user.

> return to top