^{Ooh La La} Ga La - Car                                                                                                                                                                   The One Stop that Suits your Style, since 1989

 Complete Interview Questionnaire and Profile. Send to: ms.cade@galacar.com

INDEPENDENT PROFILE STATUS  

Date:______________________  Referred by:__________________________________________ ID# _______

DESIRED OPPORTUNITY: ___________________________________ID#:_______________ Your ID will begin  with your level, area code and followed by numbers selected by the company and ending with 2 initials.  Your ID# will not be changed without proper authorization. ID# Example: L1-904-1BE. 

NAME:    ___________________________________________         DATE OF BIRTH: ___________________________AGE:_______        __________________________                                 

ADDRESS: ______________________________________________________________________________________________________

TELEPHONE: ___________________________EMAIL ADDRESS: ________________________________CELL:__________________

MAILING  ADDRESS:____________________________________________________________________________________________________

IN CASE OF AN EMERGENCY, NOTIFY: _____________________________________  TELEPHONE NUMBER : ______________________

Are you a Citizen of the USA? Yes or No  Alien Registration Number:________________________

Education

What is the highest school grade completed? _____________Degree: Yes (Field) / No :_____________________________ Certification: Yes (Field)/ No : ___________________________License: Yes (Field)/ No :____________________________ Are you a student? Yes/No   Name of school attending: __________________________________, State:__________________

Employment History

Present Firm Name: _______________________________________State:______________, Zip: ____________           Years employed: _______ Position: _______________________________Salary:__________________

REASON (S) FOR LEAVING: _________________________________________________________________________

Previous Firm Name: _______________________________________State:______________, Zip: ____________         Years employed: _______ Position: _______________________________Salary:__________________

REASON (S) FOR LEAVING: _______________________________________________________________________

ADDITIONAL INFORMATION

FUTURE GOALS: _______________________________________________________________________________

Will this be a main source of earnings? Yes /No  Are there any illnesses that could inhibit performance? Yes /No

CONFIDENTIAL & OFFICE USE ONLY:

Recommendations:_____________________________________________________________________________________________

Receipt Date: __________________________________Receipt Time: _______________________________