Please provide the following contact information: 

Choose one of the following options: BS, BA Degree or higher No 4 year degree

Enter the Year of graduation:

Enter your College or University in the space provided below.

Enter your College Major in the space provided below.

What was your GPA?

What was your SAT score?

What was your ACT score?

Are your currently employed? Yes No

List your current and previous jobs over last 5 to 10 years (Title, Company, Dates, Salary/Comm, Reason for Leaving):

Do you have a successful career path?

Have you demonstrated increased responsibilities (briefly explain)?

Do you have current/previous outside business to business sales experience?
  Yes No

If you do have outside sales experience, how many years?

Outstanding awards or accomplishments in each job: 

How many reps are in your division or district selling the same items are selling and reporting to the same manager?

Consistently, how have you ranked in the divisional sales numbers?

How many reps are in the Region selling the same items you are selling?

Consistently, how have you ranked in the Regional sales numbers? 

How do you rank Nationally?

Do you have a valid driver's license? Yes No

State:

Do you have more than two moving driving violations in the last 12 months?
  Yes No

Have your ever pled guilty or "no contest" to, or been convicted of, a misdemeanor or felony? Yes No

If Yes to question 25, please provide date (s), offense and location and any other relevant information:

Note: This does include convictions for DWI or DUI, but does not include minor traffic violations. Answering "Yes" to this question does not constitute an automatic bar to employment. If you are not sure, it is better to answer Yes and find no record in the background check than to answer No and a record is discovered on the background check.

Would you relocate? Yes No

If yes, what is their area of preference?

Are you interested in selling in an operating room environment?
Yes No

Are you interested in selling in a Home Health Care environment? 
Yes No 

When are you available for hire (Two weeks notice) ? 
-- mm/dd/yy

Is this to be kept CONFIDENTIAL? Yes No 

Are you interviewing with other companies? Yes No

If you are interviewing, what companies and what stage of the cycle?

Why do you want to leave your current job?

Do you have a non-compete or disclosure clause that will prevent you from working with this company?

What makes you an above average sales person?