Questionnaire

Thank you for your interest in Specialisterne USA.

This questionnaire is used to collect information from those interested in future work opportunities with one of our corporate partners. By completing it, it will be easier to notify you about work opportunities in your area of interest.

When you have completed the questionnaire, please send a recent resume to Specialisterne USA, at the following email address: resumes.USA@specialisterne.com
* Questions with an * are mandatory.

Please complete the following:

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* 1. Please complete the following:

Street Address

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* 2. Street Address

City

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* 3. City

Zip Code

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* 5. Zip Code

Email

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* 6. Email

Alternate Email

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* 7. Alternate Email

Primary Phone

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* 8. Primary Phone

Alternate Phone

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* 9. Alternate Phone

How did you hear about us?

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* 10. How did you hear about us?

Enter referral details here (please limit your response to 250 characters)

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* 11. Enter referral details here (please limit your response to 250 characters)

Please select the statement that best describes your current situation.

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* 12. Please select the statement that best describes your current situation.

How old are you?

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* 13. How old are you?

What is your gender?

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* 14. What is your gender?

Do you currently have a Vocational Rehabilitation counselor in your state of residence?

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* 15. Do you currently have a Vocational Rehabilitation counselor in your state of residence?

The Specialisterne Assessment Program takes place at the employer's offices prior to employment. Please indicate any areas that you could commute to or where you have a support network that could accommodate you during the 4 weeks.

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* 16. The Specialisterne Assessment Program takes place at the employer's offices prior to employment. Please indicate any areas that you could commute to or where you have a support network that could accommodate you during the 4 weeks.

Would you be willing to relocate for full time employment?

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* 17. Would you be willing to relocate for full time employment?

What education level have you completed?

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* 18. What education level have you completed?

In which field have you completed an education?
Note: If you are still in High School please do not answer this question.
If you are currently in school, please indicate your expected graduation date.

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* 19. In which field have you completed an education?
Note: If you are still in High School please do not answer this question.
If you are currently in school, please indicate your expected graduation date.

If you are currently employed please describe your current situation.

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* 20. If you are currently employed please describe your current situation.

How many years of professional experience do you have?

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* 21. How many years of professional experience do you have?

Do you hold any professional certifications?

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* 22. Do you hold any professional certifications?

What are some of your interests and/or hobbies? (Select all that apply)

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* 23. What are some of your interests and/or hobbies? (Select all that apply)

What motivates you to have and hold a job?

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* 24. What motivates you to have and hold a job?

How far are you willing to commute to work daily?

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* 25. How far are you willing to commute to work daily?

How much time are you willing to spend commuting to work each day?

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* 26. How much time are you willing to spend commuting to work each day?

What kind of transportation is available to you and are you prepared to take on a daily basis for your commute to work or school?

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* 27. What kind of transportation is available to you and are you prepared to take on a daily basis for your commute to work or school?

Do you have a driver's license and could you drive as part of your job?

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* 28. Do you have a driver's license and could you drive as part of your job?

Would you be willing/able to travel as part of your job.

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* 29. Would you be willing/able to travel as part of your job.

If your resume is available online, please enter the address where it can be viewed.
(Alternatively, email a copy of your resume to resumes.USA@specialisterne.com)

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* 30. If your resume is available online, please enter the address where it can be viewed.
(Alternatively, email a copy of your resume to resumes.USA@specialisterne.com)

I understand that my participation in any Specialisterne Assessment Program is completely voluntary and travel expenses may not be reimbursed.

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* 31. I understand that my participation in any Specialisterne Assessment Program is completely voluntary and travel expenses may not be reimbursed.

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