Career Development Registration Form
Please complete and return this form to enable our staff to better assist you with career and job search coaching. All information you provide is confidential and will be treated as such.
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To be eligible for Career Development services, you must be a regular, full-time employee who has completed their 3-month orientation period in good standing.
Do you meet these requirements?
Yes
No
How did you hear about Career Development Services?
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Date of first appointment (mm/dd/yyyy):
*If you have not yet scheduled an appointment, please call 859-257-9416 to do so.
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First Name:
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Last Name:
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Best Phone Number to Contact You:
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What number is this?
Work
Home
Cell Phone
Other
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E-mail address:
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May we contact you at this e-mail address?
Yes
No
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Employee ID Number:
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Total years of employment at UK:
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Please select the Sector below which best
represents the area of the University for which you work:
Chandler Hospital
Good Samaritan Hospital
UK Healthcare (excluding the hospitals)
Provost/UK HealthCare Colleges (e.g. Medicine, Pharmacy, Health Sciences, etc)
Provost/Academic Colleges (College of Agriculture, Arts & Sciences, etc)
President's areas (e.g. Athletics, Office of Development, External Affairs, etc)
Finance and Administration (e.g. Campus Services, Treasurer, HR, IT, Facilities Management, EEO, etc)
Other
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Specific department where you are currently employed:
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Current job title:
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Start date (month/year) in current position:
Current position grade:
Current salary:
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Are you an exempt or non-exempt employee?
Exempt (salary)
Non-Exempt (hourly)
Campus mailing address
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Office number and building name (or street address)
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Department name
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City
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State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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Zip Code
Other employment at UK (if applicable)
Job title & position grade:
Department:
Approx. Dates (mm/yy):
Job title & position grade:
Department:
Approx. Dates (mm/yy):
Education/Certification/Training
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What is the highest level of education you have completed?
High School Diplopa/GED
Some college but no degree
Associates Degree
Bachelor's Degree
Graduate Level Degree
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Briefly list any other relevant continuing education, certifications, SAP, supervisory or professional development training you have completed or are working towards:
A Little More About You
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1. What is the purpose of your first appointment?
Career Counseling
Cover Letter Writing
Displaced Employee
Interview Coaching
Job Enrichment
Job Search Strategies
Managerial/Departmental Consultation
Resume Writing
Other
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2.
What outcomes do you hope to achieve as a result of career counseling and/or job search coaching?
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3.
What are your current career goals? (However uncertain, list any thoughts that you might have.)
4.
If you could obtain any
specific position(s)
or
types of jobs
at
U.K.
, what are some examples?
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5. Do
you have a preference for working on Campus or in the Healthcare Enterprise?
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Is there anything else you would like your career coach to know in order to help you?
PLEASE NOTE
If you are seeking help improving your job search strategies,
please bring relevant documents with you
, e.g. resume, OES application, job postings you have or plan to apply for.
Thank you! We look forward to meeting you!
-Career Development Staff
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Indicates Response Required