Career Resource Center · Career Resource Center Membership Registration Form

Contact Information

Name

*

Prefix

First Name

Last Name

Suffix

Email

*

Verify Email

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

County

*

Township

*

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?

Submit Registration and Payment Options

Check the box next to Membership Fee, click the button to proceed to submit registration and proceed to payment options. You can select credit card or Paypal to process your membership fee.

If you have a PROMO code, enter it here

Amount

*

$250 - Annual CRC Membership Fee