Name: 
  Company: 
Address 1: 
Address 2: 
     City:  ST:  ZIP Code: 
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Telephone: (Home) (Work)
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Job-related Information (To select more than one option use the control key)
Type of work preferred:  (check all that apply) Direct Hire   Contract   Contract to hire Job#: (from Jobs page, if applicable)
Hardware Knowledge: (select all that apply) Mainframe Client/Server Midrange PC Other	Software Knowledge: (select all that apply) Cobol/CICS RPG Financial SAP/ABAP Oracle C / C++ Visual Basic JAVA Other
Type of pay rate preferred: (choose either hourly or salary and put your target wage in the field next to your choice) Hourly   $/hr Salary   $/yr	Comments and extra info:
Location Information
Preferred region to work: (select all that apply) Midwest Southwest East coast Northeast Southeast	Preferred state: Are you willing to relocate? Yes  No Are you willing to travel? Yes  No