ProTech, Inc. plasticsgal
Ann Johnson
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Thank you for your interest in ProTech, Inc.

To help us help you, we request that you complete the following questionnaire requesting information about you. Evaluating career options is a complex task, and this questionnaire is intended to assist both of us in understanding the numerous factors affecting your career search.

Because we believe your answers to many of the questions listed will clarify key issues of your search, it is well worth your time and serious thought to complete this form.

There are portions of the form that may not apply to your specific situation, and of course, all questions are optional. However, please understand that the more information you provide, the better we can be of service in representing you.

First Name: Last Name:
  (Nickname)
  Address:
  City   State        Zip
Phone (H):
Phone (W):
Ext:
Phone (Cell):
Phone (Fax):
Phone (Pager):
Email (H):
Email (W):

What is the best time to contact you?
Ok to Call at Work? Yes No
Have you already decided a change is needed? Or are you still in the process of deciding?
Are you still employed?Yes No If not, when was your last day of employment? (mm/dd/yy)
What motivates you to seek a new position? (If checking more than one, please rank from 1-5 with #1 being your highest motivation)
Greater challenge or job satisfactions Rank
Greater compensation Rank
Resigned (why?) Rank
Relocation to more satisfying area Rank
Laid off due to RIF Rank
Dismissed (why?) Rank
Instability of current employer Rank
Other (specify) Rank
Is your current employer a division of another company? Yes No
  (Who?)
Are there any firms that we should not contact in order to prevent duplication or possible confidentiality problems?
Are there any firms that you would like us to explore for you?
What specific job title are you seeking?
  1st Choice
  Alternate
  Alternate
Marital Status
Single Married 		Spouse name
 Spouse occupation
Number of children to be considered if relocation required? Their ages
Do they have any special needs that are to be considered? Yes No
If so, what?
What are your normal work hours?    From: am pm         To: am pm
Will you consider shift work? Yes No
Ok on 2nd (3-11 p.m.) Ok on 3rd (11 p.m.- 7 a.m.) Ok on 12 hour shifts OK on Contract
OK temps OK temp to perm    
Housing status: Rent/live with relatives Own/buying home Other (what?)
Will you consider relocating yourself for a good opportunity? Yes No
Please mark all that apply using a 1-9 rating system
(1 means you are highly motivated to go to that area).
If you do not want to relocate to a certain area, please leave that area blank.
0 = ME, VT, NH, MA, RI, CT, NJ 7 = AR, LA, OK, TX
1 = NY, PA, DE 8 = NM, CO, WY, ID, UT, AZ, NV
2 = MD, VA, WV, NC, SC 9 = WA, OR, CA, HI, AK
3 = GA, FL, TN, AL, MS CX = Canada
4 = KY, OH, IN, MI MX = Mexico
5 = WI, MN, IA, ND, SD, MT IX = International
6 = IL, MO, KS, NE
Rank in order of preference (1-3): Metropolitan area Suburban area Rural
List any geographic areas you want us to concentrate on.
Why is this your geographical focus?
Will you travel as part of your job? Yes No What percentage of travel is acceptable?
What is your current/most recent annual base salary? $
Or Hourly Rate? $ 		What was your last W2?
$
Do you earn overtime?
Yes No 		(last year's total overtime amount)
$
Do you have a bonus plan?
Yes No 		(last year's total bonus amount)
$
Do you have a profit sharing plan?
Yes No 		(last year's total amount)
$
When and how much was your last salary increase?       Mo/yr         $

What percentage of a raise do you expect this year?
%
When would it be due?

Are you near any milestones for vesting or retirement programs?
Yes No
When due?

Assuming an equal cost of living, what is your target salary range for this move?
From $ To $
Are you legally authorized to work in the United States? Yes No
Will you, now or in the future, require sponsorship for employment status (e.g. H-1B visa status)? Yes No
ProTech belongs to a national network of independent professional search firms. Given the parameters outlined in this questionnaire, do you authorize us to provide your credentials to affiliated recruiters in order to give you more opportunities to review and select from?
Yes No
(Contact from member firms should come directly to you with reference to us.)

If after you receive an offer for employment from a new company, your existing company counter-offers to match what the new employer is giving, what would your response be to that counter-offer?
Do you know of any condition that would prevent you from passing a physical examination or drug screen prior to employment? Yes No
What physical handicaps/limitations do you have?
How long have you actively been considering a change?
less than a month 3-6 months 6-12 months always looking
In the past 6 months, approximately how many contacts have you had with prospective employers?
Employer phone interview Direct employer application Offers
Personal interview Recruiter conversations Offers refused
Do you have the following credentials for car rental purposes during plant visits?
Drivers' License Yes No Major credit card (Visa, Master Card, etc.) Yes No
What is the closest airport for you to use?
How did you hear about ProTech, Inc.?
What newspapers or trade magazines do you normally monitor for employment advertising?
What month and year did you receive your...
High School Diploma or GED? Mo/Yr: Associates degree? Mo/Yr: GPA:
Bachelors degree? Mo/Yr: GPA: Masters' degree? Mo/Yr: GPA:
PhD degree? Mo/Yr: GPA: Apprenticeship? Mo/Yr:
  In what disciplines?:
Are your college transcripts in your possession? Yes No
Do you hold any patent disclosures? Yes No For what?
What career related awards have you received?
What additional courses or seminars have you attended?
What professional registrations or certifications do you hold (if any)
(ASQC/CQE, Certified Plant Engr, P.E.)?
To what industry organizations/associations do you belong?
List any secondary languages you can read/speak and indicate fluency?

What are your hobbies and pastimes?
Most clients require that we complete a reference check (or the client, themselves check references on candidates) prior to extending an offer.
Please list below 4 business references (Supervisors, Peers or Associates) for this purpose.
We will not proceed with a reference check unless we advise you first; but having these on file will avoid delays at a critical stage in the employment process.
  Name Job Title Home Phone Work Phone
1
2
3
4
We are constantly on the lookout for good talent. Your confidential recommendation of another plastic professional is highly appreciated.
Tooling Engineer
 Contact number
Mold Maker
 Contact number
Process Engineer
Contact number
Shift Supervisor
Contact number
Process Technician
Contact number
Anyone else that might be confidentially looking
Contact number
What sets you apart from your peers? Please provide examples of projects or accomplishments that demonstrate your ability. (Be specific in terms of results as in % gain, dollars saved, etc.)
 
What criteria will you use in making a decision on your job choice? (List in order of importance.)
  1.
  2.
  3.
  4.
  5.
  6.
What motivates you to do your best?
 
What are your long-term career goals?
1 year
3 years
5 years
Please indicate what level of experience in the following areas using a 1 to 5 rating system. The 1 rating would indicate light experience while the 5 rating would mean very strong experience.
All terms should be rated for on-the-job experience you have had. Strictly reading material regarding the subject matter or taking a course should not be considered as actual experience.
These are important for screening purposes. Should you have other key words that need to be included, please list them in the space provided below the process skill set listing.
PROCESSES:
Adhesives Compound resins Non woven Specialty Chemicals
Assembly Compression molding Pipe extrusion Stretch blow mold
Blow mold Equipment Manufacturer Polymerization Stretch film extrusion
Blown film extrusion Expandable polystyrene Printing Structural foam molding
Bulk molding compound Extruded sheet, rigid Profile extrusion Thermoforming
Calendering Extrusion blow mold Pultrusion Tooling
Cast film extrusion Foam processing Reaction injection molding Transfer molding
Cast sheet extrusion GMP/FDA Recycled materials Tube extrusion
Coatings Gas assist injection molding Reheat blow molding Vacuum forming
Coextruded film Injection blow molding Reinforced plastics Wire extrusion, jacketing
Coextruded sheet Injection molding Rotational molding Yarn/fiber Extrusion
Color concentrates Insert molding Rubber processing    
Co-injection molding Lamination Sheet molding compound    
SKILLS:
Adhesive & bonding Equipment design/modify Plumbing repair Source tooling
ANSI Codes FMEA Pneumatic maintenance Startup
ASTM Codes Finite element analysis Preventive maintenance Statistical process control
Certified quality auditor Flexographic printing Predictive maintenance Statistical quality control
Certified quality engineer Formulations Process development Supplier quality
Certified quality manager Gravure printing Process troubleshooting Team experience
Closed loop equipment Hands-on technical skills Product or part design Thermoplastic materials
CNC operator High speed packaging Production scheduling Thermoset materials
CNC programming High volume production Project management skills Thin Wall Molding
Coatings Hydraulic maintenance Prototyping Tool/mold building
Computer aided mfg In-mold label/decorate QS 9000 Tool/mold design
Computer integrated mfg ISO 9000, 9001, 9002 Rapid prototyping Tool/mold repair
Cost estimating part/product Jig/fixture design RF sealing Tool startup/debug
Cost reduction Just-in-time techniques Robot programming Total quality management
Customer interface Kaizen Robot maintenance/repair Turn around experience
Design of Experiment Machine shop skills SMED Twin screw extrusion
EDM Maintain secondary equipment Sample materials UV curing
Electrical maintenance Optimize cycle Sample molds/tooling Vacuum metalizing
Electronic/PLC maintenance Offset printing Side wall printing Welding
Electroplate finishing P&L responsibility 6 sigma Work cell/focus factory
Electrostatic painting PLC programming Single screw extrusion  World class manufacturing 
Other
Please list any cad experience that you have had (i.e. ProEngineer, Moldflow, AutoCAD Release 12/13, Catia, Computervision, Excel, MasterCAM, SDRC, 3-D, 2-D, Solid Modeling or similar items) and indicate level of proficiency by using a 1 to 5 scale.
Materials: Please list the specific materials you have worked with, starting with your strongest. (For example, ABS, HDPE, LDPE, PVC, Nylon, Glass Filled Nylon, etc.)
 
What specific products have been produced at the facilities you have worked at? Please start your list with your current or most recent company and work backwards.
 
Equipment: Please list specific brand names, presses or die sizes, etc., of equipment you have experience with for any of the processes you have worked with. For example, HPM, Van Dorn, Cincinnati-Milacron, injection molding machines with press sizes ranging from 80 tons to 2000 tons....or Welex extruders with 2 1/2" dies.
 
Please share any other information with us that you believe would be helpful in our search for your new position/company.
 

RESUME

If you have not already done so, please send us your resume.  It can be sent in a Word document format as an email attachment to: plasticsgal@mindspring.com. Or, you may copy and paste it directly in the email.  Or, mail to: ProTech, 855 Caler Road, Brasstown, NC 28902; or, fax to: 828-835-8213.  If you need any assistance in preparing a resume, let us know and we will help you, at no charge to you, of course.
 

I hereby certify that (to the best of my knowledge) all of the foregoing information is true and correct. I further authorize ProTech, Inc., to release confidential information and conduct reference checks in the performance of their normal employment activity. I understand that all due precautions will be taken to maintain my confidentiality and to present my qualifications accurately, but I agree to hold ProTech, Inc., harmless from any breach of confidentiality caused by any other party.

Full Name
Date

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ProTech, Inc. 855 Caler Road, Brasstown, NC 28902
828-835-8464, 828-835-9957 fax 828-835-8213
(professional technical industries, Inc.)

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