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:
* Questions with an * are mandatory.

* 1. Please complete the following:

* 2. Street Address

* 3. City

* 5. Zip Code

* 6. Email

* 7. Alternate Email

* 8. Primary Phone

* 9. Alternate Phone

* 10. How did you hear about us?

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

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

* 13. How old are you?

* 14. What is your gender?

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

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

* 17. To which assessment or work location are you closest? Those with an * are states with no current activity but with a goal to become active in the near future.

* 18. What education level have you completed?

* 19. In which field have you completed an education?
Note: If you are still in High School please do not answer this question.

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

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

* 22. Do you hold any professional certifications?

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

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

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

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

* 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?

* 28. If your resume is available online, please enter the address where it can be viewed.
(Alternatively, email a copy of your resume to

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