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Career Resource Center Membership Registration Form
Contact Information
Name
*
Prefix
First Name
Last Name
Suffix
Email
*
Address
*
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
County
*
Township
select one
Antioch
Avon
Benton
Cuba
Ela
Evavnston
Fremont
Grant
Lake Villa
Libertyville
Maine
McHenry
Moraine
Newport
Northfield
Shields
Vernon
Warren
Wauconda
Waukegan
West Deerfield
Wheeling
Zion
Other
I don't know
Cell Phone
Home Phone
Are you a previous CRC Member?
Yes
No
PERSONAL DATA
Gender
Male
Female
Birthdate
(mm/dd/yyyy)
Marital Status
select one
Single
Married
Separated
Divorced
Widowed
Children
Yes
No
Ethnicity
*
African-American
Asian/Pacific Islander
Caucasian
Hispanic/Latino
Multi-Racial
Native American
Other
Is English your native language?
*
Yes
No
CRC REFERRAL INFORMATION
How did you discover CRC?
*
Family/Friend
CRC Member/Alumni
Internet
CRC Booth
Media
Religous
IDES Office/Township
Library
Career Center
Networking Group
Social Service Agency
College
Professional Referral
Other/Unknown
Name of Referring Person or Organization
Employment Status
I am currently:
*
Employed
Unemployed
If you indicated that you are Unemployed please give a reason for your Unemployment
Downsized
Merger
Relocation
Recent Grad
Re-entry
Other
If you selected "Other" as your Unemployment Reason please describe below.
Date of unemployment
(mm/dd/yyyy)
If Unemployed, did you receive outplacement assistance?
Yes
No
EDUCATION
Undergraduate Degree/Institution
Graduate Degree/Institution
Certifications/Professional Designations
EMPLOYMENT HISTORY
Past Employment Overview
*
i.e. 12 years HR Mfg
Last/Current Employer
Last/Current Position
Dates Employed
i.e. MM/YY - MM/YY or MM/YY to present
Salary
Reason for Leaving
Most Recent Job Function
Accounting/Finance
Administrative Services
Arts/Applied & Fine
Banking/Financial Services
Communications/PR
Consulting/Entrepreneur
Education
Engineer/R&D
General Management
Government/Public Administration
Healthcare/Hospital
Hospitality/Travel/Entertainment
Human Resources/Training
Legal
Marketing/Advertising
Mathematics
Operations/Quality
Recreation/Sports/Fitness
Sales/Customer Relations
Scientist/Research
Real Estate/Facilities/Construction
Social Service/Nonprofit
Supply Chain/Logistics
Technology/IT/IS/Telecom
Other - please describe in next question
EMPLOYMENT GOALS
Are you looking for Full or Part-time Employment?
Full-time
Part-time
What is your salary goal?
What is your desired position?
Submit Registration and Payment Options
Please select the registration fee and click on the PayPal logo. You do not need a PayPal account for payment. Once you click on the logo you will be taken to a PayPal login window with the option to pay with a Debit or Credit card located at the bottom. Thank you!
If you have a Virtual Tour Code enter it here:
If you have a referral code, enter it here
Amount
$250
-
Annual CRC Membership Fee
Amount
$225
-
$25 off CRC Annual Membership
Registration Submission and Payment
Please select the registration fee and click on the PayPal logo. Please note you do not need a PayPal account to pay for registration. You will be taken to another PayPal screen where there is an option to choose pay with Debit or Credit at the bottom. Thank you!