Date
* Position Title
* First Name
* Last Name
* Name of Firm or Corporation:
* Address 1
Address 2
* City
* State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
* ZIP
* Work Phone
* FAX
* E-Mail
How did you hear about us?
Other:
If you are a corporation,
what industry are you in?
Other:
If you are at a law firm,
what practice area is the job in?
* Do candidates need to
have a college degree?
Yes No
* Is this a new position?
Yes No
* What is the minimum
number of years of
experience needed?
* What salary range do you
want to pay?
If you are a publicly traded
company, are candidates
eligible for stock options?
Yes No
* How soon do you wish to
have the position filled?
Would you like a KBA
Associate to contact you
regarding this position or
other positions within the
company?
Yes No
Would you like KBA to
send you a brochure
describing their services?
Yes No
Would you like KBA to
send you a FREE salary
survey?
Yes No