Contact Information:

First Name:				Last Name:
Email:				Address:
Home Phone:				City:
Cell Phone:				State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
				Zip:

Professional Information

What best describes your current situation? Select 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 Havent found yourself? Choose this.

Title best describing your current/last position: Select 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

Education: Select BA/BS Masters Ph.D J.D./LLD Military Some College No College

Currently Employed? yes no		If not, how long have you been unemployed? Select Less than 15 days 15-30 days 30-45 days 45-60 days Longer than 60 days

Current Income: Select Under $50,00 50-70 70-90 90-120 120-150 150+		Desired Income: Select Under $50,00 50-70 70-90 90-120 120-150 150+		Years Experience: Select 1-5 6-10 11-15 16-20 21-25 26+
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  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)

How did you hear about us? Internet Word of Mouth Yellow Pages Newspaper Referral Other
Copy and paste a copy of your resume here:
Thank you for taking the time to provide us your information.

Privacy Policy
At AMG FLORIDA SEARCH we are 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
AMG FLORIDA SEARCH will not reveal any personal information that users provide to us to any third party without their permission.

General
AMG FLORIDA SEARCH 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.