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					                                                                Triumph Professional Staffing

                                                    Ft. Lauderdale Office:                       Miami Office:
                                                    100 W. Cypress Creek Rd.                     5201 Blue Lagoon Dr.
                                                    Suite #1020                                  Suite #884
                                                    Ft. Lauderdale, Florida 33309                Miami, FL 33126
                                                    Ph 954-634-0777                              Ph 305-944-0101
                                                    Fax 954-634-0770                             Fax 305-944-5241




                             Confidential Applicant Information
                               Recruiters Name You are Working With @
                                    Triumph Professional Staffing



First Name                          Middle Name                                 Last Name



Address

Permanent                                                 e-mail




                                                          SSN



Phone
             Area   Number          Extension                         Area          Number
Home                                                      Cellular

Work                                                      Pager



Education
  Year                Degree                    Major                                        School




Other                                                                                                          Y        N
                                                                                         Permanent
Current Commute                                     Are you willing to relocate?
                                                                                         Contract
Maximum
                                                    Maximum Travel %
Commute
                                                      Confidential Applicant Information
Employment History (most recent first)
Dates: from                         To                    Company

Position Title                                                           City/State
Supervisor’s
                                                                         Telephone
Name & Title
Co’s Product/Services/                                                   Co.
SIC Code                                                                 Revenue
Compensation-Base                                         Bonus                                   Total Compensation

Number Supervised                                                            Reason for leaving
List your top 3 responsibilities in priority order:

1.

2.

3.
Employment History
Dates: from                       To                      Company

Position Title                                                           City/State
Supervisor’s
                                                                         Telephone
Name & Title
Co’s                                                                     Co.
Product/Services                                                         Revenue
Compensation-Base                                         Bonus                          Total Salary

Number Supervised                                       Reason for leaving
List your top 3 responsibilities in priority order:
1.
2.
3.
Employment History
Dates: from                         To                    Company

Position Title                                                           City/State
Supervisor’s
                                                                         Telephone
Name & Title
Co’s                                                                     Co.
Product/Services                                                         Revenue
Compensation-Base                                            Bonus                       Total Salary

Number Supervised                                       Reason for leaving

List your top 3 responsibilities in priority order:
1.
2.
3.
Name:
                                         Professional References

We require 3 professional references to include a minimum of 2 supervisors. Please contact these
individuals and let them know your representative from Triumph Professional Staffing will be calling them
to corroborate the details discussed during the screening process.

    *Supervisors      Company             Title            Telephone       Telephone       May we contact?
       Name                                               Number (W)       Number (H)        Yes    No
*

*




                                                  * Required
        Peers         Company             Title             Telephone      Telephone       May we contact?
                                                           Number (W)      Number (H)     Yes       No




    Subordinates      Company             Title            Telephone       Telephone       May we contact?
                                                          Number (W)       Number (H)     Yes   No




        Other         Company             Title            Telephone       Telephone       May we contact?
    (former client,                                       Number (W)       Number (H)      Yes       No
    external CPA,
    external legal
    counsel, etc.)
                         Confidential Applicant Information


                                        SECURITY RELEASE

I certify that the information provided herein is correct and complete. I authorize TRIUMPH
PROFESSIONAL STAFFING, or its designated representative, to investigate and verify any of the
information bearing on my employability and to use this information in connection therewith. I
authorize and request any and all persons including, without limitation, employers, former employers,
references, schools, credit agencies, law enforcement agencies, other government agencies and any
other person who may have information relative to my abilities, business activities, police record,
educational history, etc., to disclose all information to TRIUMPH PROFESSIONAL STAFFING or its
representatives, and I release TRIUMPH PROFESSIONAL STAFFING, TRIUMPH PROFESSIONAL
STAFFING representatives, employers, former employers, references, school, agency and persons
and their successors or assigns from any and all liability of whatever nature arising from the
investigation into my background by reason of furnishing such information to TRIUMPH
PROFESSIONAL STAFFING or its representative.

I understand that any misrepresentation (by omission or concealment or by false, misleading or
partial answers) may result in the withdrawal of work opportunities or the cancellation of contracts.

I understand that the offer of work opportunities with TRIUMPH PROFESSIONAL STAFFING could be
contingent upon satisfactory completion of any investigation which TRIUMPH PROFESSIONAL
STAFFING may undertake or direct concerning myself or any information furnished in connection with
my candidacy for employment.



Candidate Name:


Social Security No.


Signature of Candidate                                            Date
                                        Confidential Applicant Information

                       PLEASE RANK ON A SCALE OF 1-5 (5 INDICATING EXPERT)
                                 ADMINISTRATIVE SKILLS
SOFTWARE:
Access                     Peoplesoft                      Quattro Pro          Timberline
Excel                      Platinum                        Quicken              Word
Lotus                      PowerPoint                      Quark                WordPerfect
Outlook                    Peachtree                       QuickBooks           Other

SKILLS:
Medical Billing            Payroll, Tax                    Shorthand            Supervisor
Mortgage & Title           Purchasing                      Supervised 1-5       Transcription
Payroll, In-House          Phones 0-10 Lines               Supervised 6-10      Typing Skills 35-55 WPM
Payroll, Services          Phones 10-+ Lines               Supervised 11+       Typing Skills 55-75 WPM

OTHER:
Administration             - O Development                 Strategic Planning
Disaster Recovery          - Comp & Benefits
Government Contracts       - HRIS - Recruiting
Human Resources            International Experience

LANGUAGES:
Speak Chinese              Speak German                    Speak Japanese       Speak Spanish
Write Chinese              Write German                    Write Japanese       Write Spanish
Speak French               Speak Italian                   Speak Portuguese     Speak Other
Write French               Write Italian                   Write Portuguese     Write Other
LOCATION:
FLA CITIES:
Boca Raton                 Fort Lauderdale                 Miami                Sarasota/Bradenton
Coconut Grove              Fort Myers                      Miami Beach          St Petersburg/Clearwater
Coral Gables               Gainesville                     North Miami          Sunrise
Coral Springs              Hollywood                       Naples               Tampa
Deerfield Beach            Jacksonville                    Orlando              Tallahassee
Daytona Beach              Key West                        Pensacola            West Palm Beach

EAST COAST STATES:
Alabama                    Louisiana                       Mississippi          North Carolina
Connecticut                Maine                           New Hampshire        Rhode Island
Delaware                   Massachusetts                   New Jersey           South Carolina
Georgia                    Maryland                        New York             Texas
                                                                                Virginia

OTHER STATES:
Arizona                    Kansas                          New Mexico           Tennessee
Arkansas                   Kentucky                        New Hampshire        Utah
California                 Louisiana                       Nevada               Vermont
Colorado                   Maine                           North Dakota         Washington
Hawaii                     Minnesota                       Ohio                 West Virginia
Idaho                      Michigan                        Oregon               Wisconsin
Indiana                    Missouri                        Oklahoma             Wyoming
Iowa                       Montana                         Pennsylvania         Other
Illinois                   Nebraska                        South Dakota
                                         Confidential Applicant Information

                             PLEASE RANK ON A SCALE OF 1-5 (5 INDICATING EXPERT)
                                                         INDUSTRIES
Advertising Agency                Cruise Lines                  Insurance – Life         Pharmaceutical/Bio Tech
Agricultural Production           Defense/Gov’t Contractor      Investment Co.           PEO
Aircraft/Aerospace                Distribution                  Insurance – Title        Radio/TV
Amusement/Recreation              Education                     Internet                 Real Estate – Development
Architect/Engineering             Electric/Gas/Sanitary         International – All      Real Estate – Property Mgmt.
Auto Dealers                      Entertainment                 Leather Mfg.             Restaurants
Bank (Independent)                Electronics/Technical         Leasing                  Re-Insurance
Bank (Savings)                    Electronics Mfg.              Legal Services           Retail
Beverages                         Financial Services            Lumber & Wood            Rubber Manufacturing
Biotech                           Furniture Manufacturing       Machine Manufacturing    Staffing Company
Bookkeeping Services              Floral                        Manufacturing - All      Scientific Manufacturing
Brokerage                         Freight Forwarding            Metal Fabrication        Service Company – Misc.
Casino                            Food Service                  Medical Equipment        Software Development/Sales
Call Center                       For Profit School             Media                    Steel Manufacturing
Chemical Manufacturing            Government                    Medical                  Stone/Glass/Concrete
Communication Services            Healthcare (All)              Merchant Services        Securities/Brokers
Computer Program/Software         Healthcare – Managed Care     Mortgage Company         Telecommunications
Construction                      Hospital/Medical              Motor Freight            Textile Manufacturing
Consumer Products                 Holding Companies             Non-Profit               Transportation (Air)
Consulting                        Hotels                        Oil and Gas              Travel Agency
CPA Firm/Public “Big 5”           HVAC                          Public Relations         Trust Company
CPA Firm other                    Insurance Agents              Paper Products Mfg.      Wholesale Dist. (Durable)
Credit Agency – Personal          Insurance – Casualty          Plastics Manufacturing   Wholesale Dist. (Non-Durable)
Credit Agency – Commercial        Insurance – Health            Printing/Publishing

				
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Description: Real Estate Brokerage Powerpoint document sample