Assessment Request Form

Bill To
Company*
Contact Person
Contact Phone Number
Billing Address
*Only complete if this is your first time requesting an assessment through Revela.

Street Address City State ZIP Code
Candidate Information
Candidate Name*
First Last
Candidate Email Address*
What date would you like the assessment to be sent?
*If no date is entered, assessment will be sent the day the form is submitted.
Date Format: MM slash DD slash YYYY
Assessment Information
Which assessment would you like to send?*
- Profile XT (multi-purpose assessment used for hiring and coaching)
- PXT Select (one person, one position)
- Profiles Sales Assessment (a version of the PXT used specifically for sales positions)
- Everything DiSC® (information about a person's communication style)
Which reports would you like to receive?*
- Interview Guide (used for interviewing candidates for a specific position)
- Performance Model Comparison (compares against a Performance Model)
- Comparison Summary (general overview of the comparison)
- Executive Leadership Report (used to assess Executives and C-Suite positions)
- Individual Profile (provides a guide for self-understanding)
- **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
Who should receive the results?*
Other Information
Please enter any other information we should know. (Example: Allocate to Branch #123 on the invoice.)

Assessment Request Form

Bill To

Candidate Information

Assessment Information

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