Resume Consent Consent Form: Local Candidates Please complete this form to give AquantUs your consent to release your resume. SECTION 1: GENERALName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Include your email address hereCompany Name and Job Title(Required)Company NameJob Title Add RemoveCopy and paste the Company Name and Job Title of the position you're applying to from the email you received from the recruiter.Consent to Submit Resume(Required) I have not, directly or indirectly, previously submitted my resume to the above referenced company for any position via any other means (including, but not limited to, the internet, another recruiter, or my own network). I give AquantUs, LLC sole consent to release my resume to the above referenced company. I have previously submitted my resume to the above referenced company via a source other than AquantUs. I have previously submitted my resume(Required) MM slash DD slash YYYY Input the most recent date, position and method used to apply to a position with this company.I have previously submitted my resume(Required)Position(s) applied forMethod(s) of submission Add RemoveInput the most recent date, position and method used to apply to a position with this company.SECTION 2: COMPENSATIONMy current (or most recent) annual base salary is(Required)Please enter a number from 10000 to 999999.Please exclude bonus or other variable compensation from this line. Amount may be verified as part of our client's on-boarding process.My most recent cash bonus was(Required) I received a cash bonus I did not receive a cash bonus Cash Bonus amount(Required)List the cash bonus amount and date paid (mm/dd/yyyy)Date paid(Required) MM slash DD slash YYYY List any other cash and/or non-cash compensation For example: Signing bonus, stock options, restricted stock, retention bonus, etc.AmountList any outstanding loans or other liabilities to current employer that must be repaid For example: Signing bonus, tuition reimbursement, certification costs/courses, etc. AmountMy required "base" salary for the above position is(Required)Please enter a number from 10000 to 999000.Please exclude expected bonus or other variable compensation from this line.My first available start date is(Required) MM slash DD slash YYYY I am legally authorized to work in the United States for any employer(Required) Yes No Visa requirements(Required)Please provide details regarding your work eligibility including type of visa (H1B, TN1, etc.) or work permit, applicable expiration dates, and any other work restrictions.SECTION 3: VERIFICATIONVerification(Required) I understand that any extended offers of employment will be contingent upon successful completion of 1) verification of employment eligibility in the United States, 2) a background check, 3) verification of education, and 4) a drug screen. I confirm the degrees and any certifications (i.e. CPA, CIA, etc.) listed on my resume have been issued by the appropriate school and/or issuing authority and are not “in process” or “pending”. I understand that any misrepresentations in this form or on my resume could result in any offer being rescinded. Use the text box below to provide details on any matters that may arise during the verification and background checks outlined above.Provide Details on Any Matter(s) That May Arise During Verification ProcessSECTION 4: SUBMISSIONEmailThis field is for validation purposes and should be left unchanged.