HIRE SUCCESS
EMPLOYMENT TESTING SYSTEM

SPECIAL STATISTICAL STUDY
APPLICATION FORM

For Authorized Use Only

Note: ALL FIELDS ARE REQUIRED. YOU WILL NOT BE ABLE TO SUBMIT THIS FORM UNTIL ALL ARE FILLED OUT COMPLETELY.

Please Enter Your Name, Address, and Telephone numbers below:

First Name:
Last Name:
... Address:
......... City: .. State:
...Zip Code: (Postal Code in Canada)
.....Country:

Telephone Number: Number is Home Office

Your E-Mail Address:....
Your Personality Profile and all correspondence will be sent to this e-mail address.

Please Enter Any ID Code You Chose as Your Unique ID: (One word only)

This code will be used in place of your name to provide you with anonymity on the Personality Profile Report and when associated with any data collected from this point forward.

The following information is required for Eligibility Purposes at this time. The Study Administrator will use it only to make sure not demographic area represents too large of a sample for this study. Minorities and people from all employment areas are encouraged to participate in this Study.

Your eligibility will be reviewed by the Study Administrator, and if accepted, you will be sent instructions and and Authorization Code so you may proceed.