Ronald L. Krannich - The Re-Entry Employment and Life Skills Pocket Guide: Your Passport to Renewed Success

Provide basic personal information that might appear on a job application or resume, including a street mailing address.

Name (full) _________________________________

Street address _______________________________

City _______________________________________

State________________Zip Code________________

Other mailing address __________________________

Date of birth ___________________ Age _______

Place of birth ______________________________

Social Security # __ (memorize or put in secure place) __

Drivers license # ___________________________

Special drivers licenses: ______________________

Marital/family status:

Single Married Divorced Widow/widower

Number of children: ______

U.S. citizenship:

Yes No (explain status __________________

__________________________________________)

If a military veteran, complete the following:

Branch of service: __________________________

Years served: _____________________________

Highest rank: ______________________________

Honorably discharged: yes no

Copy of DD-214 form: yes no

Emergency contact:

Name ____________________________________

Address __________________________________

Phone number ______________________________

Primary physician:

Name ____________________________________

Address __________________________________

Phone number ______________________________

Blood type: __________________________________

Special medications: ___________________________

Health (physical or mental) issues affecting work: _____________________________________________

Highest formal education level attained:

Schools attended beyond 8th grade, with dates:

Special licenses/certificates, with dates:

High school attended:

Name __________________________

Address ________________________
_______________________________

Years attended: _______ to _______

Highest grade completed: 9 10 11 12

Diploma: Yes No GPA (4.0 system) : ______

Other high schools attended (names/dates):

High school equivalent:

GED (year: _______) Other (______)

Favorite subjects:

Major accomplishments:

MOST RECENT COLLEGE/UNIVERSITY ATTENDED:

Name __________________________

Address ________________________
_______________________________

Accredited institution: Yes No

Type: residential distance learning/online

Years attended: _______ to _______

Credit hours completed: _______ GPA: _______

Major(s): ______________________

Minor(s): ______________________

Degree: Yes No (When expect? _______

Key skills acquired: ________________
_______________________________
_______________________________

Key accomplishments: _____________
______________________________
______________________________
______________________________

OTHER COLLEGE/UNIVERSITY ATTENDED:

Name __________________________

Address ________________________
_______________________________

Accredited institution: Yes No

Type: residential distance learning/online

Years attended: _______ to _______

Credit hours completed: _______ GPA: _______

Major(s): ______________________

Minor(s): ______________________

Degree: Yes No

Key skills acquired: ________________
_______________________________
_______________________________

Key accomplishments: _____________
______________________________
______________________________
______________________________
______________________________

OTHER EDUCATION/TRAINING EXPERIENCE:

Name __________________________

Location _______________________
_______________________________

Length of program (specify one):

Days ( __ ) Weeks ( __ ) Months ( __ ) Years ( __ )

Dates: From ______ To ______

Type of experience: ________________
_______________________________
_______________________________

Certificate, degree, diploma received: __
_______________________________

Key skills acquired: ________________
_______________________________
_______________________________

Equipment or tools used in training: ____
_______________________________
_______________________________

OTHER EDUCATION/TRAINING EXPERIENCE:

Name __________________________

Location ________________________
_______________________________

Length of program (specify one):

Days ( __ ) Weeks ( __ ) Months ( __ ) Years ( __ )

Dates: From ______ To ______

Type of experience: ________________
_______________________________
_______________________________

Certificate, degree, diploma received: __
_______________________________

Key skills acquired: ________________
_______________________________
_______________________________

Equipment or tools used in training: ____
_______________________________
_______________________________

Employer ____________________________

Street address ________________________

City, state, ZIP code ___________________

Website _____________________________

Phone number ________________________

Job title _____________________________

Employment dates: From ______ To ______

Salary: Start __________ End __________

Raises: Yes No Promotions: Yes No

Job duties and responsibilities: ___________
__________________________________

Major skills used: ____________________
__________________________________

Major accomplishments: _______________
__________________________________
__________________________________

Reason for leaving: ___________________

Supervisors name: ___________________

Employer ____________________________

Street address ________________________

City, state, ZIP code ___________________

Website _____________________________

Phone number ________________________

Job title _____________________________

Employment dates: From ______ To ______

Salary: Start __________ End __________

Raises: Yes No Promotions: Yes No

Job duties and responsibilities: ___________
__________________________________

Major skills used: ____________________