career counseling intake form

In order to better understand the nature of your career counseling appointment, please complete this intake form.

Name

First Name

Last Name

Date

YYYY

Do you have a job?

Yes

What is your reason for seeking career counseling?

Employment Information

Please complete this section and attach a copy of your most up to date resume.

If you are currently unemployed, how long since you were last employed?

Current Employer:

Position/Type of work:

Dates of Employment:

Are you having difficulties/issues in your current Job?

Yes

If YES, please briefly describe those difficulties:

Other Employment History

Please list below Other Employers, Position/Type of Work and Dates of Employment

What makes you a good employee?

What do you think are the greatest barriers you currently face in your future planning?

Volunteer and other Recreational Activities:

List your hobbies, recreational activities and volunteer involvement:

Military History

Provide branch, rank, enlistment dates, type of discharge:

Education/Training

Please list your High School, Location and Graduation Date

Favorite High School Class:

Least Favorite High School Class:

Please list your College, Location and Graduation Date

Major(s)/Degrees

Advanced Degree(s)

Additional Training:

Professional Certifications:

Computer/Software Knowledge:

APPOINTMENT TIME REQUESTED (Select One)

814 Nantasket Ave Hull, MA 02045

Wednesday 9am-Noon

409 Washington Street Weymouth, MA 02188

Friday 3pm-6pm

**We will contact you to set and confirm your appointment**

PLEASE LET US KNOW THE BEST WAY TO CONTACT YOU

Phone

(###)

###

####

career counseling intake form

In order to better understand the nature of your career counseling appointment, please complete this intake form.

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