Please complete this questionnaire:
* all fields must be completed.

Full Name	First	*
	Middle
	Last	*
	Email ID:	*
	Reenter Email ID:	*
Marital Status	please select Single Married *
Children	please select Yes No *
Are You an Australian Citizen?	please select Yes No *
If not, please specify citizenship	*
Do you hold an Australian passport	please select Yes No *
Date of Birth	JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 *
City of Residence	*
Are you willing to Relocate Now	please select Yes No *
How Much Notice do you need to relocate?	please select 1 week 2 week 3 week 4 week 5 week 6 week more than 6 weeks *
Do You Have a Diploma?	please select Yes No *
Do You Have a Degree?	please select Yes No *
How many years of work experience do you have	*
Years of Industry-Related Work Experience	*
Current Rate	Select	please select Hourly Daily Monthly Annually *
	From	*
	To	*
Preferred US Cities to Work In	1.
	2.
	3.
Top 3 Skills	1.
	2.
	3.
Are you Currently Having Interviews for Jobs in the USA?	please select Yes No *
If Yes, Please Explain / Detail	*
Have You Had a USA Visa Recently?	please select Yes No *
If Yes, What Type?	*
How Did You Hear About CXC?	please select Google SMH AD SMH online CXC AUSTRALIA CXC UK CXCUSA website Other *
Please Specify	*
Please Include a 2 Page Resume with this Questionnaire	*
Please enter the code shown above	*