Professional Placement Submit a Candidate Profile Online Form

I. Demographics
     
Name
  
Current Title
 
Current Affiliation
 
   
Address 1
  
Address 2
 
City
  
State
  
Zip
  
                 
Phone
  
   
Fax
        
E-Mail Address
        
           

II. Desired Position

Medical Director
Staff Physician
Program Director
Sales Professional
Other (Please Specify):
 

III. Degree of Interest

Actively looking. Definitely in the market for a new position
Passively looking. Might be interested in the right opportunity
 

IV. Relocation

Unwilling to relocate
Willing to relocate only to (state or regions):
Willing to relocate except to (state or regions) :
Willing to go anywhere for the right opportunity
 

V. Desired Compensation
       

a. Compensation range. What are your total compensation requirements, including commissions, bonuses, and other financial incentives?
           
 
           

b. Describe the nature of any compensation incentives, if any, (e.g., bonus, commission, incentives clauses)

           
 
           

c. Describe any other compensation issues that you consider important
(e.g., equity or ownership opportunities, special benefits
           
 
     
   

VI. Candidate Attribute Profile (Indicate on the scale of 7 to 1 how you would best describe yourself: (note – your preferences will be compared to the “ideal candidate” description that we receive for position openings)

Authoritative 7 6 5 4 3 2 1   Collaborative
Clinically focused 7 6 5 4 3 2 1   Administratively focused
Early career 7 6 5 4 3 2 1   Late career
Extrovert 7 6 5 4 3 2 1   Introvert
Entrepreneurial 7 6 5 4 3 2 1   Altruistic
Employer-oriented 7 6 5 4 3 2 1   Worker-oriented
Incentive driven 7 6 5 4 3 2 1   Security driven
Physically active 7 6 5 4 3 2 1   Laid back/sedate
Aggressive 7 6 5 4 3 2 1   Passive
Prefer to be in clinic 7 6 5 4 3 2 1   Prefer to be at the worksite
Academic 7 6 5 4 3 2 1   Real world
Tenacious 7 6 5 4 3 2 1   Patient
Unilateral decision-maker 7 6 5 4 3 2 1   Decisions by consensus
Short term oriented 7 6 5 4 3 2 1   Long term oriented
Strong voiced 7 6 5 4 3 2 1   Soft spoken
Independent worker 7 6 5 4 3 2 1   Likes group dynamics


VII. Other Issues
       

a. Briefly describe your idea position.

       
 
           

b. What do you consider to be your most compelling professional skills and traits?

           
 
           

c. What do you consider to be your most compelling personal traits?

           
 
     

d. Why are you considering a new position at the present time?

           
 
     
   

e. Please elaborate on any other issues that you would like to address (e.g., family issues, special needs etc.):

           
 
   
 
   
     
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