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Experience

Client #1

Primary Responsibilities:

Accomplishments:

Compensation (annual salary, hourly rate or project fee):

Bonus:

Project Duration:

From:    To:

Client #2

Primary Responsibilities:

Accomplishments:

Compensation (annual salary, hourly rate or project fee):

Bonus:

Project Duration:

From:    To:

If you have been a consultant for longer than one year, please describe additional projects on which you have worked:

Please briefly indicate the types of positions and/or consulting assignments for which you feel you are best suited:

Education

Please list the degree(s) received, school name and year awarded:

BA:   JD: BS:   PhD: MBA:   Masters: Honors Awarded:

Certifications or Professional Credentials Awarded

Check all which apply:

CPA   CFA   CFP   CMA   CCIM   CEBS CPM   CPIM   SE3   SE6   SE7   SE63 Others:

Language Fluency

Please check all languages in which you are fluent in either oral or written communication:

Spanish   French   German   Chinese   Japanese Others:

Systems Expertise

Please check any systems areas (in column 1) where you are qualified to act as a consultant or part of a technical project team.

For IT recruitment professionals, please indicate (in column 2) in which areas you have recruited professionals

Information Technology Qualified Recruited Voice/Data/Video LAN/WAN Voicemail/E-Mail Internet Web Page Development Electronic Commerce Intranets New Media/Multimedia Client Server Systems Mainframes Other

Information Management Qualified Recruited Financial Modeling:     Excel Lotus Other Large Scale Databases:     Oracle Sybase Other User Databases:     Paradox FoxPro Microsoft Access Other

Financial Applications Qualified Recruited Oracle Financial PeopleSoft Microsoft Project Payroll QuickBooks Peachtree Other

Manufacturing Qualified Recruited MRP MRD ASK/MANMAN SAP CAD/CAM Other

Employment Preferences

Please rate in order of preference: (1 being the highest, 6 being the lowest)

Permanent part-time employment Select 1 2 3 4 5 6 Regular full-time employment Select 1 2 3 4 5 6 Full-time consulting work Select 1 2 3 4 5 6 Part-time consulting work Select 1 2 3 4 5 6 Project work leading to full-time employment Select 1 2 3 4 5 6 Consulting from home office only Select 1 2 3 4 5 6

Locations

What locations are acceptable? Check all that you will consider:

Downtown Chicago Chicago Suburbs - North Chicago Suburbs - Northwest Chicago Suburbs - Northeast Chicago Suburbs - South Chicago Suburbs - Southwest Chicago Suburbs - Southeast Chicago Suburbs - West Chicago Suburbs - North Shore

Compensation

Hourly billing rate range:

Minumum Acceptable : $   to preferred: $

Our candidates typically bill our clients, directly, on a 1099 basis. However, if the client requires a W-2 arrangement, would you be willing to work on a W-2 basis as a temporary employee?

Yes No

Professional References

Once you have been chosen for a specific project/position, we contact your professional references.

Reference #1 Name : Title : Company : Phone : Relationship : Reference #2 Name : Title : Company : Phone : Relationship : Reference #3 Name : Title : Company : Phone : Relationship :

Additional Comments

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Notice:

By clicking on the button below, I hereby confirm that the information stated above is accurate, to the best of my knowledge. It also authorizes Executive Options to contact my references when I am being selected for a project/position.