Independent careers advice and guidance<BR>
		Consultancy and training services
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Please complete the questionnaire as fully as possible. We wil use the information to prepare for your appointment.
Title:
First Name:
Last Name:
Home Address:
Town:
Postcode:
Telephone:
E-mail:
What would you
like to discuss?
Current/most recent occupation:
What were the main
tasks involved in this?
Please indicate any
additional support you
might need in employment:
Any other personal
issues which could affect
your career choice?
(E.G., family commitments):
Hobbies and interests?
What do you consider
your greatest strength?
What do you consider
your biggest weakness?
Employment history,
with approximate dates:
Main qualifications
(subjects, level and grades):
Any other training
or experience:
Do you have a
driving license?
Do you have
access to a car?
Any other comments you
feel are relevant:
Data Protection Act - information is being requested
Any information you give us will be used only to help us respond to your request. We will not pass
any information to any third party.

If you intend to book a consultation, and you have difficulty with stairs, please let us know when you make
your appointment in order that we can arrange the use of an accessible room.
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Mobile: 07915 047951  spacer  Email: enquiries@cptees.co.uk

© 2011 Career Plan Tees