CLIENT QUESTIONNAIRE & PROFILE SHEET

1. NAME _____________________________________________
2. WHAT CITY & STATE DO YOU LIVE IN? _____________________________________________________
3. WHAT TYPE OF CRIME WERE YOU CONVICTED OF?
_____________________________________________________
4. WHEN WERE YOU CONVICTED?
_____________________________________________________
 5. WHAT TYPE OF JOB ARE YOU SEEKING?
_____________________________________________________
6. WHAT EXPERIENCE DO YOU HAVE?
_____________________________________________________
7. DO YOU POSSESS ANY SPECIAL TRADES? COLLEGE EDUCATION?
_____________________________________________________
8. ARE YOU CURRENTLY ON PROBATION OR PAROLE?
______________________________________________________
9. HOW DID YOU HEAR ABOUT US? _______________________________________________________

IT WILL TAKE A FEW DAYS FOR YOUR EMPLOYMENT JUMP START PACKAGE TO BE READY. PLEASE BE PATIENT. IF YOU DO NOT HAVE AN EMAIL ADDRESS PLEASE PROVIDE A MAILING ADDRESS.
EMAIL ADDRESS__________________________________________
MAILING ADDRESS________________________________________