Career Resource Center · 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

Cell Phone

Home Phone

Are you a previous CRC Member?

Yes

No

PERSONAL DATA

Gender

Male

Female

Birthdate

(mm/dd/yyyy)

Marital Status

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

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

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?

Amount

*

$250 - Annual CRC Membership Fee