<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <html><head> <meta http-equiv="Content-Type" content="text/html; charset=unicode"> <meta content="MSHTML 6.00.3790.2541" name="GENERATOR"></head> <!-- #include VIRTUAL="menu.htm" --> <!-- #include VIRTUAL="StyleSheet.inc" --> <body><br> <table style="WIDTH: 50%" cellSpacing="3" cellPadding="5" width="50%" align="center" border="0" background=""> <tr> <td> <P align=center><FONT face=Arial size=2>If you have any questions about completing the questionnaire or the exercise itself please contact Martin Hoyle at <A href="mailto:martin@pcsmailbox.com">martin@pcsmailbox.com</A> or call +61 414 800 425</FONT></P></td></tr> <tr> <td> <p align="center">Please complete all of the following information. Contact details will only be used in relation to this exercise, and will not be retained or disclosed beyond this.</p></td></tr></table><br><br> <table style="WIDTH: 500px" cellSpacing="3" cellPadding="3" width="500" align="center" border="0"> <tr> <form action="form_ac.asp" method="post" id="form1" name="form1"> <td> <p align="right">Name :</p></td> <td><input style="WIDTH: 250px; HEIGHT: 22px" maxLength="60" size="30" name="Name" value="Please Enter"></td></tr> <tr> <td> <p align="right"> Date of Birth (DD/MM/YYYY) :</p></td> <td><input style="WIDTH: 250px; HEIGHT: 22px" maxLength="60" size="29" name="DOB" value="Please Enter"></td></tr> <tr> <td> <p align="right">Country of origin :</p></td> <td><select style="WIDTH: 250px" size="1" name="Country"> <option value="Afghanistan">Afghanistan</option> <option value="Albania">Albania</option> <option value="Algeria">Algeria</option> <option value="Andorra">Andorra</option> <option value="Angola">Angola</option> <option value="Anguillia">Anguillia</option> <option value="Antigua &amp; Barbuda">Antigua &amp; Barbuda</option> <option value="Argentina">Argentina</option> <option value="Armenia">Armenia</option> <option value="Aruba">Aruba</option> <option value="Ascension">Ascension</option> <option selected value="Australia">Australia</option> <option value="Austria">Austria</option> <option value="Azerbaijan">Azerbaijan</option> <option value="Bahamas">Bahamas</option> <option value="Bahrain">Bahrain</option> <option value="Bangledesh">Bangledesh</option> <option value="Barbados">Barbados</option> <option value="Belarus">Belarus</option> <option value="Belau (Palau)">Belau (Palau)</option> <option value="Belgium">Belgium</option> <option value="Belize">Belize</option> <option value="Benin">Benin</option> <option value="Bermuda">Bermuda</option> <option value="Bhutan">Bhutan</option> <option value="Bolivia">Bolivia</option> <option value="Bosnia-Hercegovina">Bosnia-Hercegovina</option> <option value="Botswana">Botswana</option> <option value="Brazil">Brazil</option> <option value="British Indian Ocean Territories">British Indian Ocean Territories</option> <option value="British Virgin Is.">British Virgin Is.</option> <option value="Brunei Darussalam">Brunei Darussalam</option> <option value="Bulgaria">Bulgaria</option> <option value="Burkina Faso">Burkina Faso</option> <option value="Burma">Burma</option> <option value="Burundi">Burundi</option> <option value="Cambodia">Cambodia</option> <option value="Cameroon">Cameroon</option> <option value="Canada">Canada</option> <option value="Cape Verde">Cape Verde</option> <option value="Caymen Is.">Caymen Is.</option> <option value="Central African Republic">Central African Republic</option> <option value="Chad">Chad</option> <option value="Chile">Chile</option> <option value="China">China</option> <option value="Christmas Is.">Christmas Is.</option> <option value="Cocos (Keeling) Is.">Cocos (Keeling) Is.</option> <option value="Columbia">Columbia</option> <option value="Comoros">Comoros</option> <option value="Congo">Congo</option> <option value="Costa Rica">Costa Rica</option> <option value="Croatia">Croatia</option> <option value="Cuba">Cuba</option> <option value="Curacao">Curacao</option> <option value="Cyprus">Cyprus</option> <option value="Czech Republic">Czech Republic</option> <option value="Denmark">Denmark</option> <option value="Djibouti">Djibouti</option> <option value="Dominica">Dominica</option> <option value="Dominican Republic">Dominican Republic</option> <option value="East Timor">East Timor</option> <option value="Egypt">Egypt</option> <option value="El Salvador">El Salvador</option> <option value="Equador">Equador</option> <option value="Equitoral Guinea">Equitoral Guinea</option> <option value="Eritrea">Eritrea</option> <option value="Estonia">Estonia</option> <option value="Ethiopia">Ethiopia</option> <option value="Falkland Is.">Falkland Is.</option> <option value="Faroe Islands">Faroe Islands</option> <option value="Fiji">Fiji</option> <option value="Finland">Finland</option> <option value="France">France</option> <option value="French Guiana">French Guiana</option> <option value="French Polynesia">French Polynesia</option> <option value="French Southern &amp; Antarctic Territories" >French Southern &amp; Antarctic Territories</option> <option value="French west Indies">French west Indies</option> <option value="Gabon">Gabon</option> <option value="Gambia">Gambia</option> <option value="Gaza &amp; Khan Yunis">Gaza &amp; Khan Yunis</option> <option value="Georgia">Georgia</option> <option value="Germany">Germany</option> <option value="Ghana">Ghana</option> <option value="Gibraltar">Gibraltar</option> <option value="Greece">Greece</option> <option value="Greenland">Greenland</option> <option value="Grenada">Grenada</option> <option value="Guam">Guam</option> <option value="Guatemala">Guatemala</option> <option value="Guinea">Guinea</option> <option value="Guinea-Bissau">Guinea-Bissau</option> <option value="Guyana">Guyana</option> <option value="Haiti">Haiti</option> <option value="Honduras">Honduras</option> <option value="Hong Kong">Hong Kong</option> <option value="Hungary">Hungary</option> <option value="Iceland">Iceland</option> <option value="India">India</option> <option value="Indonisia">Indonisia</option> <option value="Iran">Iran</option> <option value="Iraq">Iraq</option> <option value="Irish Republic">Irish Republic</option> <option value="Israel">Israel</option> <option value="Italy">Italy</option> <option value="Ivory Coast">Ivory Coast</option> <option value="Jamaica">Jamaica</option> <option value="Japan">Japan</option> <option value="Jordan">Jordan</option> <option value="Kazakhstan">Kazakhstan</option> <option value="Kenya">Kenya</option> <option value="Kirghizstan">Kirghizstan</option> <option value="Kiribati">Kiribati</option> <option value="Korea (North)">Korea (North)</option> <option value="Korea (South)">Korea (South)</option> <option value="Kuwait">Kuwait</option> <option value="Laos">Laos</option> <option value="Latvia">Latvia</option> <option value="Lebanon">Lebanon</option> <option value="Lesotho">Lesotho</option> <option value="Liberia">Liberia</option> <option value="Libya">Libya</option> <option value="Liechtenstein">Liechtenstein</option> <option value="Lithuania">Lithuania</option> <option value="Luxembourg">Luxembourg</option> <option value="Macao">Macao</option> <option value="Macedonia">Macedonia</option> <option value="Madagascar">Madagascar</option> <option value="Malawi">Malawi</option> <option value="Malaysia">Malaysia</option> <option value="Maldives">Maldives</option> <option value="Mali">Mali</option> <option value="Malta">Malta</option> <option value="Marshall Islands">Marshall Islands</option> <option value="Mauritania">Mauritania</option> <option value="Mauritius">Mauritius</option> <option value="Mexico">Mexico</option> <option value="Micronesia">Micronesia</option> <option value="Moldova">Moldova</option> <option value="Monaco">Monaco</option> <option value="Mongolia">Mongolia</option> <option value="Montenegro">Montenegro</option> <option value="Montserrat">Montserrat</option> <option value="Morocco">Morocco</option> <option value="Mozambique">Mozambique</option> <option value="Myanmar">Myanmar</option> <option value="Namibia">Namibia</option> <option value="Nauru Island">Nauru Island</option> <option value="Nepal">Nepal</option> <option value="Netherlands">Netherlands</option> <option value="Netherlands Antilles">Netherlands Antilles</option> <option value="New Caledonia">New Caledonia</option> <option value="New Zealand">New Zealand</option> <option value="Nicaragua">Nicaragua</option> <option value="Niger Republic">Niger Republic</option> <option value="Nigeria">Nigeria</option> <option value="Norfolk Island">Norfolk Island</option> <option value="Northern Mariana Is.">Northern Mariana Is.</option> <option value="Norway">Norway</option> <option value="Oman">Oman</option> <option value="Pakistan">Pakistan</option> <option value="Panama">Panama</option> <option value="Papua New Guinea">Papua New Guinea</option> <option value="Paraguay">Paraguay</option> <option value="Peru">Peru</option> <option value="Philippines">Philippines</option> <option value="Pitcairn Island">Pitcairn Island</option> <option value="Poland">Poland</option> <option value="Portugal">Portugal</option> <option value="Puerto Rico">Puerto Rico</option> <option value="Qatar">Qatar</option> <option value="Reunion">Reunion</option> <option value="Romania">Romania</option> <option value="Russia">Russia</option> <option value="Rwanda">Rwanda</option> <option value="Samoa">Samoa</option> <option value="San Marino">San Marino</option> <option value="Sao Tome &amp; Principe">Sao Tome &amp; Principe</option> <option value="Saudi Arabia">Saudi Arabia</option> <option value="Senegal">Senegal</option> <option value="Serbia">Serbia</option> <option value="Seychelles">Seychelles</option> <option value="Sierra Leone">Sierra Leone</option> <option value="Singapore">Singapore</option> <option value="Slovak Republic">Slovak Republic</option> <option value="Slovenia">Slovenia</option> <option value="Solomon Islands.">Solomon Islands.</option> <option value="Somalia">Somalia</option> <option value="South Africa">South Africa</option> <option value="South Georgia">South Georgia</option> <option value="South Sandwich Is.">South Sandwich Is.</option> <option value="Spain">Spain</option> <option value="Spanish North African Terr.">Spanish North African Terr.</option> <option value="Spitzbergen">Spitzbergen</option> <option value="Sri Lanka">Sri Lanka</option> <option value="St Helena">St Helena</option> <option value="St Kitts &amp; Nevis">St Kitts &amp; Nevis</option> <option value="St Lucia">St Lucia</option> <option value="St Pierre &amp; Miqueldon" >St Pierre &amp; Miqueldon</option> <option value="St Vincent &amp; Grenadines">St Vincent &amp; Grenadines</option> <option value="Sudan">Sudan</option> <option value="Suriname">Suriname</option> <option value="Swaziland">Swaziland</option> <option value="Sweden">Sweden</option> <option value="Switzerland">Switzerland</option> <option value="Syria">Syria</option> <option value="Taiwan">Taiwan</option> <option value="Tajikistan">Tajikistan</option> <option value="Tanzania">Tanzania</option> <option value="Thailand">Thailand</option> <option value="Tibet">Tibet</option> <option value="Togo">Togo</option> <option value="Tonga">Tonga</option> <option value="Trinidad &amp; Tobago" >Trinidad &amp; Tobago</option> <option value="Tristan de Cunha">Tristan de Cunha</option> <option value="Tunisia">Tunisia</option> <option value="Turkey">Turkey</option> <option value="Turkmenistan">Turkmenistan</option> <option value="Turks &amp; Caicos Is.">Turks &amp; Caicos Is.</option> <option value="Tuvalu">Tuvalu</option> <option value="Uganda">Uganda</option> <option value="Ukraine">Ukraine</option> <option value="United Arab Emirates">United Arab Emirates</option> <option value="United Kingdom">United Kingdom</option> <option value="United States">United States</option> <option value="Uraguay">Uraguay</option> <option value="Uzbekistan">Uzbekistan</option> <option value="Vanuatu">Vanuatu</option> <option value="Vatican City State">Vatican City State</option> <option value="Venezuela">Venezuela</option> <option value="Vietnam">Vietnam</option> <option value="Virgin Is. (US)">Virgin Is. (US)</option> <option value="Wake Is.">Wake Is.</option> <option value="Wallis &amp; Futuna Is.">Wallis &amp; Futuna Is.</option> <option value="Western Samoa">Western Samoa</option> <option value="Yemen">Yemen</option> <option value="Zaire">Zaire</option> <option value="Zambia">Zambia</option> <option value="Zimbabwe">Zimbabwe</option> </select></td></tr> <tr> <td> <p align="right">Company :</p></td> <td> <input style="WIDTH: 250px; HEIGHT: 22px" maxLength="60" size="29" name="Company" value="Please Enter"> </OPTION> </td></tr> <tr> <td> <p align="right"> Job Title :</p> <td> <input style="WIDTH: 250px; HEIGHT: 22px" maxLength="60" size="29" name="Job_Title" value="Please Enter"> </td> <tr> <td> <p align="right"> Preferred contact number :</p></td> <td> <input style="WIDTH: 250px; HEIGHT: 22px" maxLength="60" size="29" name="Contact_Number" value="Please Enter"> </td> <tr> <td> <p align="right"> Preferred contact email :</p></td> <td> <input style="WIDTH: 250px; HEIGHT: 22px" maxLength="60" size="29" name="Contact_Email" value="Please Enter"> </td> <tr> <td> <p align="right"> I am happy for my personal profile information to be use to create a composite profile of my team and to be shared at group level with my colleagues :</p></td> <td> <input type="radio" value="Yes" name="Allow_Share" checked>Yes <input type="radio" value="No" name="Allow_Share">No</td> </tr></table> <form action="form_ac.asp" method="post" id="form1" name="form1"><br> <table cellSpacing="1" cellPadding="1" width="80%" align="center" border="0"> <tbody> <tr> <td> <p align="center"><input id="submit1" type="submit" value="Continue" name="submit1"></p></form></TD></TR></TBODY></TABLE></body></html>