Wagner Executive Resources

Interview Form

Please fill out the following information and include a resume at the bottom. Required fields in red!

Name: Street Address:
City: State:
ZIP Code: Work Phone:
Home Phone: Cell Phone:
Fax Number: E-Mail Address:

1) Choose one of the following options: BS, BA Degree or Higher   No 4 Year Degree
2) Enter the year of graduation:
3) College or university:
4) College major:
5) Please enter your GPA:
6) What was your SAT score?
7) What was your ACT score?
8) Are you currently employed? Yes   No
9) List your current and previous jobs over the last 5 to 10 years (Title, Company, Dates, Salary/Commission, Reason for Leaving):
10) Do you have a successful career path? (Explain)
11) Have you demonstrated increased responsibilities? (Explain)
12) Outstanding awards or accomplishments in each job:
13) Do you have current or previous outside business to business sales experience? Yes   No
14) If you do have outside sales experience, how many years?
15) How many reps are in your division or district selling the same items you are selling and reporting to the same manager?
16) Consistently, how have you ranked in the divisional sales numbers?
17) How many reps are in the region selling the same items you are selling?
18) Consistently, how have you ranked in the regional sales numbers?
19) How do you rank nationally?
20) Do you have a valid driver's license? Yes   No
21) Do you have more than two moving driving violations in the last 12 months? Yes   No
22) Would you relocate? Yes   No
23) If yes, what is the area of preference?
24) Are you interested in selling in an operating room environment? Yes   No
25) Are you interested in selling in a Home Health Care environment? Yes   No
26) When are you available for hire? (MM/DD/YYYY)
27) Is this to be kept CONFIDENTIAL? Yes   No
28) Are you interviewing with other companies? Yes   No
29) If you are interviewing, what companies and what stage of the cycle?
30) Why do you want to leave your current job?
31) What makes you an above average sales person?

Wagner Executive Resources - P.O. Box 451 - Cleveland, OH 44022 - P: 440-349-9706 - F: 440-349-0225 - info@wagnerexec.com
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