XLR8 - Career History Form

Thank you for taking a moment to fill in the required information to proceed in the next step of assessment for a position with YogaHub (XLR8 Media Inc.). This is a secured form and the information will not be shared with others (click here for SSL verification).

* This information will not be the only basis for hiring decisions. You are not required to furnish any information that is prohibited by federal, state or local law.

Primary Contact
First Name	*
Last Name	*
Home Address	*
City	*
State	*
Zip/Postal	*
Country	*
Home Phone	*
Cell Phone	*
Primary Email	*
Position Applying For	*
Earnings Expected	*

I. Business Experience: Please list your current or most recent position.
Company / Organization	*
Business Address	*
City	*
State	*
Zip/Postal	*
Country	*
Phone	*
Website

Dates From		To
Your Title
Total Company Staff
Staff: Number of direct reports
Base Starting Salary	*	Bonuses/Other
Finishing Salary	*	Bonuses/Other
Immediate Supervisor
Title

What is/was your greatest accomplishment/success? How did you achieve this?
What is/was one of your biggest mistakes and how would you do it differently?
What do/did you like most about your job?
What do/did you least enjoy?
Reasons for leaving or desiring to change?

II. Education:
High School
High School Name	*
Location	*
Approximate number students in graduating class?	*
Your approximate rank from the top?	*
Final GPA	*
Extracurricular activities, honors and awards?
College/Graduate School
Name
Location
Dates From		To
Degree
Major
GPA		# of Credit Hours
Extracurricular activities, honors and awards?
Name any other educational background or schools you've attended (please provide details similar to above.)

III: Activities
Membership in professional or job-relevant organizations (you may exclude groups that indicate race, color, religion, national origin, disability, or other protected status.)
Publications, patents, inventions, professional licenses, or additional special honors or awards.
What qualifications, abilities and strong points will help you succeed in this job?
What are you weak points and areas for improvement?

IV: Career Needs:
What are your 3-5 year career objectives?

V. Other:
Do you have legal right to work for any employer in the United States? * Yes No
Would you be willing to arrange reference calls with supervisors and employers you’ve had in the past decade, as a last step before a final job offer? * Yes No
I certify that answers given in this Career History Form are true, accurate and complete to the best of my knowledge. I authorize investigation into all statements I have made on this form as may be necessary for reaching an employment decision. I understand that I may be asked to arrange reference calls with managers, supervisors and previous employers I’ve worked for. In the event I am employed, I understand that any false or misleading information I knowingly provided in my Career History Form or interview(s) may result in discharge and/or legal action. I understand that if employed, I am required to abide by all rules and regulations of the employer and any special agreements reached between the employer and myself.
		Yes, I agree.
I authorize YogaHub / XLR8 Media Inc. to do a thorough background check on my history, including but not limited to criminal and driving record.
		Yes, I agree.
Social Security Number
Drivers License Number

Additional Comments

I. Business Experience:

II. Education:

III: Activities

IV: Career Needs:

V. Other: