* Required Answers

*Street Address

*City *State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Iowa Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Missouri Minnesota Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico New York Nevada Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming *Zip *Phone

*What are your available days and times?

*1. Do you have reliable transporation?

Yes No

*2. Do you prefer working with male or female clients?

Male Female No preference

3. Do you have any specific specialties?
Ex. Personal Trainer (Kickboxing, weight training, yoga, pilates) Massage Therapist (shiatzu, deep tissue, kinesiology), etc.?
If so, please list them below:

*4. Do you have a current cpr/first aid certification? Yes No

*5. Do you have a current personal training, nutritionist, or massage therapy certification?

Yes No (If yes, please list certification and type below)

*6. What is the maximum distance are you willing to travel for a one-on-one personal training session?

Please select 0-10 miles 11-20 21-30 31-40 Any

*7. What is your desired pay per training hour?

Any $10-$15.00 $15-$20.00 $20-$25.00 $25-$30.00 $30-$35.00 Over $35.00 per session

*8. What are your goals for your fitness industry career?

*9. How long have you been exercising consistently? years

*10. What would you consider to be your best trait for working in the fitness industry and how will it help you in your career?

*11. What would you consider to be your worst trait and how has or will it affect your career?

*12. What do you enjoy the most about exercise and the personal training and fitness industry?

13. Please add any additional comments you feel pertain to this questionnaire: