Scribd Logo
Upload

Welcome to Scribd!

  • Course Questionnaire

    Uploaded by

    razia1khan165
    31 views1 page
    The document is a course questionnaire for an exclusive provider of facilities training. It collects contact information, background details, areas of interest, and how the individual heard about the course from the participant. Information such as name, job title, company, address, emergency contact and supervisor information is requested at the top, followed by questions about years of experience, education, professional organizations, topics of interest in the course, how they heard about it, whether they want email updates, if they can refer others, what they want to learn and their biggest workplace challenge.

    Original Description:

    Original Title

    CourseQuestionnaire

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document is a course questionnaire for an exclusive provider of facilities training. It collects contact information, background details, areas of interest, and how the individual heard about the course from the participant. Information such as name, job title, company, address, emergency contact and supervisor information is requested at the top, followed by questions about years of experience, education, professional organizations, topics of interest in the course, how they heard about it, whether they want email updates, if they can refer others, what they want to learn and their biggest workplace challenge.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    31 views1 page

    Course Questionnaire

    Uploaded by

    razia1khan165
    The document is a course questionnaire for an exclusive provider of facilities training. It collects contact information, background details, areas of interest, and how the individual heard about the course from the participant. Information such as name, job title, company, address, emergency contact and supervisor information is requested at the top, followed by questions about years of experience, education, professional organizations, topics of interest in the course, how they heard about it, whether they want email updates, if they can refer others, what they want to learn and their biggest workplace challenge.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    1215 Crossroads Blvd.

    Norman, OK 73072 USA

    Course Questionnaire
    Phone: (405) 321-1383 Fax: (405) 321-4533

    Exclusive provider of facilities training. www.jmcampbell.com


    The information contained in this form will be used for internal purposes only. Contact ID: ________________________
    First Name:_ _______________________________________ Middle Name: _ ______________________________________________
    Surname: _ ________________________________________ Name You Like To Be Called: _____________________________________
    Name as you wish it to appear on your certificate: _ ___________________________________________________________________
    Job Title: ______________________________________________________________________________________________________

    Company Name: _ ______________________________________________________________________________________________


    Home or Work Address: __________________________________________________________________________________________
    _____________________________________________________________________________________________________________
    City: _ ____________________________________________ State/Province:_______________________________________________
    Postal Code:_ ______________________________________ Country: ____________________________________________________
    Work Phone: _______________________________________ Extension:___________________________________________________
    Fax: ______________________________________________ E-mail:______________________________________________________
    World Area: q North America q South America q Europe q Africa q Middle East q Southeast Asia/Oceania

    Training Contact: _______________________________________________________________________________________________

    Phone: _ __________________________________________ E-mail: _ ____________________________________________________

    Immediate Supervisor: _ _________________________________________________________________________________________

    Phone:____________________________________________ E-mail: _ ____________________________________________________

    Emergency Contact: _ ___________________________________________________________________________________________

    Phone: _ __________________________________________
    Start Year at Current Position: _________________________ Number of years in the Industry: ________________________________
    Education or Background and Discipline: _ __________________________________________________________________________
    No Degree, Bachelor, Master, Doctorate / Chemical, Mechanical, Petroleum, Civil, Electrical, Operator, Maintenance

    Professional Organizations I belong to: q AlChe q ASME q AIME q API q IEEE q OTC q SPE q Other, list below:
    _____________________________________________________________________________________________________________
    I am interested in: q Gas Processing q Pipeline/Transportation q Production Faciliites q Water and Corrosion
    q Mechanical q Operations Management q Supply Chain Management q Reliability Engineering
    q Offshore q Electrical and Instrumentation q Health/Safety/Environment q Refining

    How did you hear about this course? q Campbell Web site q PetroSkills Website q Internet Search q Direct Mail
    q Other _______________________ q E-mail q Friend/Co-worker q Training advisor q Supervisor
    ______________________________ q Oil and Gas Journal q Hydrocarbon Processing Magazine q Offshore Magazine

    I would like to receive email regarding: q Updates on upcoming courses q Campbell Tip of the Month

    Do you know anyone who could benefit from a Campbell course?

    Name: _______________________________________________ E-mail: ___________________________________________________

    What I would like to learn from this course: __________________________________________________________________________

    _____________________________________________________________________________________________________________

    My biggest challenge in the workplace is: ___________________________________________________________________________

    _____________________________________________________________________________________________________________

    Gas Processing | Pipeline | Electrical | Instrumentation | Offshore | Refining | HSE | Mechanical | Produced Water | Reliability

    You might also like