Customer Survey

Required values are marked by an asterisk (*)

Applicant Information Name * Street address City State (abbr.) Postal code E-mail * Where did you hear about us?
(select all that apply Date You're Filling This Out

Work/Job Related Stuff Job Desired Will You Work For Peanuts?

Yes No

Do You Have Experience?

Yes No

Are You Over Qualified for this Job?

Yes No

How much do you really expect to get paid?
(0 = spare change; 10 = gold bars) 0 10 Likelihood we can find someone to work for less
(0 = poor; 10 = great) 0 10 Which will you do? /> In 100 words or less, tell us why we should hire you?

I'm so desprate for a job, I'll take a 20k a year paycut!

Internet
Magazine
Newspaper
Word of Mouth
Other