📝 Job Seeker Intake Form 📝 Job Seeker Intake Form Please provide your details and upload your resume (if you have one), so that we can assist in your job search. 1. Personal & Contact Information Name * Name First Name First Name Last Name Last Name Preferred Name/ Pronouns Email * Phone * LinkedIn Profile/ Personal Website (if applicable) Career Situation Current (or most recent) Employer / Position / Industry Employment Status: * Employed Laid Off Resigned Other (please specify)Other (please specify) Date of Separation (if applicable) Career Goals & Timeline What type of role are you seeking? (Title, level, industry) Preferred work setting: Remote On-site Hybrid Target start date — When would you like to begin a new role? Geographic Preferences / Relocation Considerations Midwest USSouthern USWestern USEastern US Experience & Key Skills Highest education / certifications Years of experience in current field(s) Top 3–5 professional strengths / areas of expertise Technical tools / software proficiency Languages or cross-cultural experience Career Materials & Needs Upload current resume/CV Drop a file here or click to upload Choose File Maximum file size: 134.22MB Do you need assistance with any of the following? Resume Cover Letter LinkedIn Profile Other (please specify)Other (please specify) Job Search Stage & Preferences How far along are you in your job search? Just starting Have a few applications/interviews Actively interviewing Offers received What's your daily/weekly availability for job search activities? Preferred coaching format 1:1 Coaching Group Workshops Self‑directed Resources Areas you want the most support in (select all that apply): Interview Prep Personal Branding Networking Strategy Career Coaching Assessment Tools Motivation Profile (optional) It's helpful to know what drives you—e.g., challenges, collaboration, recognition—so we can align assessed strengths with future opportunities. Psychological & Accessibility Support Would you like access to: Stress Management Resources Peer Support Groups Other (please specify) Do you need any accommodations? (e.g., tech, timing, language assistance) Networking & Connections Are you open to introductions? Recruiters Industry Professionals Peer Mentoring Alumni Groups Job Matching & Market Insight What’s your ideal salary or compensation range? Are there specific companies or sectors you're targeting? Where do you typically find job postings? (LinkedIn, Indeed, company websites, etc.) Agreement & Consent I consent to engaging in Cultural Impact’s outplacement services. I authorize the use of my data for completing assessments (e.g., TTI Success Insights). Signature / Electronic Approval Clear Submit If you are human, leave this field blank.
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