July 13, 2024
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This is a vital step that will save you time and help us serve you well. Your input allows us to better understand the employment needs, interests, and goals specific to you. Accordingly, we are in a better position to be proactive on your behalf and make the most of your valuable time by contacting you only in regard to opportunities that make the most sense for you and your family to consider. Again, as stated in our Privacy Policy, we are sensitive to privacy issues with respect to the use of this information provided to us.

"*" = Mandatory. The "tab" key is suggested for moving from field to field.

Tell us about yourself:
* First Name
Middle Initial / Name
Preferred Name /Nickname
* Last Name
* Street Address
* City * State * Zip Code


* Primary Contact Phone: Type of Phone?
Generally Preferred Windows of Time to Accept a Call at the Primary Contact Phone:
Other Contact Phone: Type of Phone?
Generally Preferred Windows of Time to Accept a Call at the Other Contact Phone:
* Primary E-mail address:
NOTE:  Many companies randomly review employee e-mail. We recommend that you use a personal e-mail account or a free account that you can obtain from yahoo.com, hotmail.com, or many other places.
Do you monitor the inbox of the above e-mail address at least once daily? yes no
* Have you ever been convicted of a felony, convicted in a military court martial, or dishonorably discharged from the military? yes no

If yes, please explain:

* Is it legal for you to work for any employer in the United States? yes no
If sponsorship is required, please explain:
Tell us about your employment:
* Are you presently employed full-time? yes no
* Current Employer (if presently employed)

* Current Job Location  (if presently employed)

* Current Annual Salary $
* Bonuses (sum of most recent 12-month period) $
* IF in the past 10 years, you have been employed with any employer for a period of less than 3 years, list that specific employer’s name and a brief explanation of your reason for leaving. Note: Your resume should include starting and ending dates in a month/year format.

* Primary motivating factors for considering other employment at this time?

* Time frame in which you seek to make an employment change?

* If you leave your current position, would your employer be surprised? yes no unsure
* Do you anticipate a counteroffer from your present employer? yes no unsure
If you do NOT anticipate a counteroffer, please know why. What are your reasons?

NOTE: Counteroffers occur much more often than many professionals realize. Many employers use them as a means to minimize interruption of work flow and to buy enough time to hire someone else. A super-majority of professionals who accept a counteroffer are not employed with the same employer one year later most often leaving for the same original reasons; or having demonstrated a willingness to leave, they become marked and on the short list in case of downsizing, reorganization, etc.
How long of a notice period would you need to give your current employer?
Tell us about your skills and interests

* Degrees held:

Bachelor's   Major
Master's Major
* Professional Certifications
Check all that apply:

Other (Describe)
* Experience
Public Accounting: 0-1 years 1-2 years 2-5 years 5-10 years 10+ years
National Public Accounting Firm Exp: 0-1 years 1-2 years 2-5 years 5-10 years 10+ years
Corporate Financial Accounting: 0-1 years 1-2 years 2-5 years 5-10 years 10+ years
Non-Profit/Government Accounting: 0-1 years 1-2 years 2-5 years 5-10 years 10+ years
Cost Accounting: 0-1 years 1-2 years 2-5 years 5-10 years 10+ years
Audit: 0-1 years 1-2 years 2-5 years 5-10 years 10+ years
Tax: 0-1 years 1-2 years 2-5 years 5-10 years 10+ years
Supervisory Experience: 0-1 years 1-2 years 2-5 years 5-10 years 10+ years
How many people have you supervised? 0-1 people 2-5 people 6-10 people 11-25 people 26+ people
In what languages can you read, write & converse? English Spanish French German Japanese
Other (Describe)

* Primary Services Expertise
(Check all items listed below for which you have some expertise and professional interest)

401K Administration Litigation Services
Accounting Systems Installation and Support Medicare Cost Report Preparation
Assurance Services Mergers / Acquisitions and Strategic Planning
Auditing: Internal (financial / operational) Peer Review
Auditing: Information System Public Accounting: Auditing
Audits / Reviews / Compilations: Public Accounting Public Accounting: Reviews and/or Compilations
Bankruptcy and Receivership Accounting Risk Management
Budgeting / Planning Sarbanes-Oxley Compliance
Business Development SEC Reporting
Computer / Information Systems Small Business - Planning and Consulting
Controllership Staff Development / Mentoring
Corporate Analysis Taxes: Compliance
Cost Accounting Taxes: Planning and Consulting
Cost Segregation and Property Tax Abatement Projects Taxes: C-corporations
Entrepreneurial / Accounting Services Taxes: Estate and Gift
Estates and Trusts: Planning, Administration and Taxation Taxes: High Net-Worth Individuals
Financial Management Taxes: International
Financial Planning: Business Taxes: Partnership / LLC
Financial Planning: Personal Taxes: S-corporations
Financial Reporting Taxes: State & Local (SALT)
Forensic Accounting Treasury Management
Government Accounting: Federal Valuation Services
Government Accounting: State and/or Local Other Professional Service
* Industry Specializations (Check all items listed below for which you have some expertise and professional interest)
Agriculture / Agribusiness Litigation Services
Auto Dealerships International Business
Closely-held Companies Labor Organizations / Trade Associations
Communications / Broadcasting Large Retail
Construction Manufacturing
Defense Contractors Municipalities / Counties / Districts
Educational Institutions Natural Resources: Oil, Gas, Mining, etc.
Entertainment / Recreation Not-for-Profit Organizations
Financial Services: Banks Nursing Home / Senior Housing
Financial Services: Broker / Dealers Pension / Employee Benefit Plans
Financial Services: Credit Unions Printing / Publishing
Financial Services: Investment Banks Professional / Amateur Sports
Franchising Professional Employer Organizations
Gaming Professional Practices: Architectural, Dental, Engineering, Legal, Medical, Veterinarian, etc.
Governmental Entities: State and/or Local Real Estate
Government Contracting Restaurants
Health Care / Medical Billing SEC-regulated Companies
High Technology Service Organizations
Insurance / Statutory: Other Specialty         Insurance Software Companies
Home Builders Telecommunications
Hospital Textiles
Hospitality / Travel Transportation: Aviation, Rail, Shipping, Trucking, etc.
Housing: HUD and Section 42 Utilities
Import / Export Waste Management / Recycling
Insurance / Statutory: Life/Health Wholesale Trade
  Other (please describe)

Tell us about your most memorable work-related achievements:  

Tell us about the best and the worst boss you ever had:

How would your co-workers describe you?

Tell us about your ideal next job:

* Describe the ideal job for you. Include factors like industry, specialty, position, duties desired, and other attributes.

* To what extent are you willing to travel?
* Are you willing to consider relocation? yes no maybe

If you answered yes or maybe, indicate in order of preference any specific geographical areas within the United States where you would seriously consider relocating, plus any other key thoughts you have on relocation. Example: Do you have a strong preference for being in or near a large city, or would you rather relocate to a medium or small city/large town environment?

If you are seriously open to relocation, do you own real estate or have an extended lease that must be addressed in order to relocate?

yes no

(Note: Most lessors are willing to terminate your lease obligation, especially if you communicate your need early and you demonstrate an openness to negotiate a reasonable settlement, such as surrendering one month’s rent in order to give the lessor time to find another tenant. Circumstances vary and depend somewhat on local market conditions.)

If you answered yes to the above question, do you believe that actually selling the real estate or negotiating a lease settlement could pose a significant problem to you being able to relocate within two months of accepting an offer of employment?

yes no

To what extent would you require paid relocation assistance in order to make a relocation move?

If willing to relocate, are there any other people who have employment or some other factor that would prevent your ability to actually relocate?

yes no

* Based on the cost-of-living in your current location, what total annual compensation
(including salary, bonus, etc.) are you looking for?


* What employment benefits are most important to you?

* Just so that we do not inadvertently exclude you from considering an otherwise ideal position, what is the minimum annual compensation you would consider for a good opportunity? In other words, you are telling us to NOT present you with anything having a starting annual compensation of less than:


* List other types of resources that you are using in your job search
(recruiters, job boards, classified ads, etc.)

List any companies / firms where you are aware your resume has
been submitted within the past six months.

NOTE: Countless professionals make Belcher & Associates their first and often only choice among employment search firms. However, if you have already contacted potential employers, this list simply allows us to make wise use of our time for you, and avoid consideration / duplication of your earlier employment contacts.

Please click the Submit button below to complete the submission process. If you provided us with an E-Mail address earlier, within a few minutes of your submission, we will automatically e-mail a confirmation receipt plus other information which may be helpful to your job search. Click the Submit button below in order to complete the registration process.

All of my Information above is Accurate and Complete

Please Note:This form can not be submitted unless this box is checked.


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