ALL MATERIALS WILL BE KEPT IN CONFIDENCE
MARINO & ASSOCIATES is an equal opportunity employer.

Please answer a few questions about your capabilities and the type of position you are seeking. When a potential match arises, we will be sure to contact you.
Please also send your resume as an E-Mail attachment in addition to filling out this form.

Disclosure Statement: I understand that all information is confidential. I understand that Marino & Associates will only provide information to their clients with my consent. I warrant all facts contained herein to be true and complete and hereby authorize Marino & Associates to act as my agent and to use the information provided while seeking employment opportunities on my behalf. I have read and understood the above.
Name of Candidate:   
You would describe your work experience under which general heading?
Referred by:   
Home Phone:   
Work Phone:   
Pager/Cell:   
What would be your ideal position (List 2):   
Salary Range: From:   
K To K
 
EMPLOYMENT EXPERIENCE (Last 10 years)
 
Title:   
Mo/Yr From:   
  To  
Company:   
Base Salary:   
Bonus:    
Commission:    
Total annual salary:    
Motivation for leaving current or last position:   
 
Title:   
Mo/Yr From:   
  To  
Company:  
Base Salary:   
Bonus:   
Commission:    
Total annual salary:   
Reason for leaving:   
  
Title:   
Mo/Yr From:   
  To  
Company:   
Base Salary:   
 Bonus:    
Commission:   
Total annual salary   
Reason for leaving:   
 
Any gaps in employment:   
Why:   
Any Supervisory experience:   
If yes, where and when:   
# of people supervised:   
 
Describe your search activity over the past  
3-6 months.  Please include any information about   interviews/offers you have had as well as  
the types of positions, etc.:   
Where are you willing to work:   
How far are you willing to commute to and from work:   
What salary do you expect in your next position:   
What are your thoughts concerning susceptibility to a   counteroffer from your current employer:  
Have you ever been given one in the past:  
Did you accept it or turn it down:  
Why:  
 
                             

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