ASSESSMENT REQUEST FORM
Bill To
Company
*
Contact Person
*
First Name
Last Name
Contact Phone Number
Accounts Payable Email
example@example.com
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Candidate Information
Candidate Name
*
First Name
Last Name
Candidate Email Address
*
example@example.com
What date would you like the assessment to be sent?
-
Month
-
Day
Year
Date Picker Icon
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Assessment Information
Which assessment would you like to send?
*
PXT Select (multi-purpose assessment used for hiring and coaching)
PXT Sales Assessment (a version of the PXT used specifically for sales positions)
Everything DiSC® (information about a person's communication style)
Other
On the Online Catalyst™ Platform?
*
Yes
No
Which reports would you like to receive?
*
Sales Individual's Feedback Report (a guide for self-understanding)
Sales Comprehensive Selection Report (one person, one position)
Sales Coaching Report (management considerations after the hire)
**Send Individual Report to Candidate
Which reports would you like to receive?
*
Comprehensive Selection Report (one person, one position)
Coaching Report (management considerations after the hire)
Individual's Feedback Report (a guide for self-understanding)
**Send Individual's Feedback Report to Candidate
How Will This Assessment Be Used?
*
Selection/Succession
Coaching/Performance
What Position Is This Person Being Considered For?
*
What Position Does This Person Currently Hold?
*
Which version of the assessment would you like?
*
Everything DiSC® Workplace
Everything DiSC® Management
Everything DiSC® Sales
Everything DiSC® Work of Leaders
**Send Individual Report to Candidate
Which version of the assessment would you like?
*
Everything DiSC® Workplace
Everything DiSC® Management
Everything DiSC® Agile EQ
Who should receive the results?
*
Other Information
Please enter any other information we should know. (Example: Allocate to Branch #123 on the invoice.) Or if you'd like another assessment for the same person, please indicate that here.
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