Online Interview

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First Name






Last Name






Address







City





State





ZIP Code





Phone





Email





Employment History

Current Employer:
Current Position:
Previous Employer:
Previous Position:


Education:




Do you have a valid state Registered Dietitian certification?
Yes
No




How many years of education have you completed?
Two-year college degree
Some college classes
Four-year college degree
Beyond four-year college degree
Master's degree


Experience:




How many years experience do you have in the position for which you are interested?
No experience
Less than one year
At least 1 to 3 years
At least 4 to 6 years
At least 7 to 9 years
Ten or more years




What type of setting best describes your work experience?
Hospital
Clinic/Fitness Facility
Home Health/Residential Care Facility
Restaurant/Hospitality
Cafeteria Setting - nonhealthcare
Food Manufacturing
Insurance
Academia/Research
Other




If applicable, what type of area describes your specialty?
Pediatric
Renal
Geriatric
Oncology/Critical Care
Weight Management
Other




Do you have experience planning and conducting nutritional education programs and materials for students and the public?
Yes
No




Do you have experience conducting research in food, nutrition and food systems?
Yes
No




Do you have experience analyzing current scientific nutritional studies on the nutritional value, taste, appearance and preparation of food?
Yes
No




Do you have experience making recommendations regarding public policy, such as school programs and/or nutritional labeling?
Yes
No




Do you have experience planning and preparing grant proposals to request program funding?
Yes
No




If you have experience managing a Food Service Department, please select the response that best describes your experience:
Coaching or training others
Team leader or supervisor
Management level
Senior Management/Executive level
No managerial experience


Work/Salary:




Would you be interested in temporary assignments or on-call work?
Yes
No




Are you able to work weekends and holidays?
Yes
No




Please indicate what annual base rate you are looking to receive:
Up to $30,000 per year
Up to $35,000 per year
Up to $40,000 per year
Up to $45,000 per year
Up to $50,000 per year
Up to $55,000 per year
$55,000 or more per year


General:




If the position requires traveling, do you have a valid driver's license and proof of automobile insurance?
Yes
No




Are you interested in working full time or part time?
Full time
Part time




Are you currently employed?
Yes
No




How many miles from your home are you willing to travel to work?
Up to 5 miles
Up to 10 miles
Up to 20 miles
Over 20 miles




Would you relocate to another state?
Yes
No




Are you at least 18 years of age and eligible to work in the United States?
Yes
No




Are you bi-lingual or multi-lingual?
Yes
No




In addition to English, in which language are you most fluent?
Spanish
French
Italian
German
Russian
Chinese
Japanese
Other
None




Would you consent to pre-commencement testing, if required, including drug screening, medical testing and/or skill-related testing?
Yes
No




Would you consent to pre-employment background checks, if required, including past employment information, education verification, and/or reference checks?
Yes
No




Are you now or have you been a member of the United States Military, National Guard or Reserves?
No
I am a Veteran of the United States military
I am currently a member of the United States military
I am currently a member of the National Guard or Reserves
I was a member of the National Guard or Reserves



Please take a moment to briefly share any additional information about yourself that you feel a prospective employer would like to know. We do not recommend pasting of resumes or cover letters.


Additional Info:
 

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