Cincinnati (513) 721-1975  
Dayton (937) 228-3731  

Online Employment Consultation

The following questions are designed to provide us with an adequate history of your employment situation. Please be assured that all information you provide to us is held in confidence. By completing the questionnaire as completely as possible we will be able to provide a more comprehensive evaluation. If you believe other information is important for us to consider, please add the material in the “other information” section at the end of this questionnaire. Thank you.

Are you: