THE INSURE SURVEY
You are now going to participate in the next step of this company's employment process. The Insure Survey will help your prospective employer understand how you work with others. This company has made the decision that this is important job-related information required of employees in the position for which you are applying. Some of the requested information may have been given by you on your Application for Employment. We would appreciate you giving the information again in this format.
Please don't attempt to give the “right” answer, rather, answer the way you truly feel. You need to know that Insure Survey has been scientifically designed to detect untruthful responses.
Start by reading the Agreement and filling out the requested information. If you need special assistance please let your administrator know now so arrangements can be made to accommodate you. Do not complete if you are in the state of Massachusetts.
AGREEMENT
I hereby authorize the evaluation of my responses to questions and statements in The Insure Survey. However, I understand that this is only one part of this company's pre-employment process and will not be the sole criterion used to make a hiring decision. I release Testwerks, Inc. and this company, their agents, distributors, officers, and employees, of and from any and all actions and causes of action of every kind, nature, and description, arising out of, or incidental to, the administration, my answers to the questions, and the evaluation reports of The Insure Survey. I hereby authorize any former or present employer, educational institution, utility company, credit bureau, governmental agency, and/or other persons to furnish any information concerning my character, credit, and employment record.
Further, I understand that the American's with Disabilities Act prohibits this company from asking prospective employees who have completed a rehabilitation program about drug/alcohol use BEFORE their rehabilitation. Therefore, if I have completed a rehabilitation program, I will respond to drug/alcohol related questions ONLY ABOUT MY DRUG/ALCOHOL USE SINCE COMPLETION OF MY REHABILITATION PROGRAM. I retain the right to omit any information prohibited by the State/Province in which I am completing The Insure Survey.
I HAVE READ, UNDERSTAND, AND AGREE TO
THE TERMS, OF THE ABOVE AGREEMENT:
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1
Testwerks, Incorporated
Copyright 2010
San Antonio, Texas
1
Insure Survey
DO NOT WRITE
IN THIS
BOOKLET
Mark only on the answer sheet
Copyright 2010, Testwerks, Incorporated, San Antonio, Texas
ALL RIGHTS RESERVED Information herein contained CANNOT BE REPRODUCED in any form of printing or by other means, electronic or mechanical, including, but not limited to, photocopying, audiovisual recording and transmission, and portrayal or duplication in any information storage system without written permission from the publisher, Testwerks, Incorporated, 9601 Broadway, Suite 100, San Antonio, Texas, 78217. The Insure Survey is designed to be interpreted using authorized software and Testwerks, Inc. is not liable for interpretations through other methods.
The Insure Survey is prepared for general use throughout the United States. Our legal counsel has advised us that all questions comply with existing Federal fair employment laws including Title VII and the American Disabilities Act. However, various laws and related statutes and interpretations of them change frequently. For this reason, neither Testwerks, Incorporated nor its counsel assume responsibility for any questions which may violate local, state, and/or Federal laws. Users should consult their counsel about any legal concerns they may have with respect to the use of this questionnaire. Do not administer this booklet in the state of Massachusetts.
THE INSURE SURVEY
SECTION I
Questions about actions you have taken in the past, how you have handled some situations, and your participation in certain activities. Each question will give you a series of possible answers. Choose only one response for each question and mark it on your answer sheet. Example:78) Have you ever gotten an award for doing good work?
A. Yes B. Maybe C. No
If you don't understand these instructions or have any other questions, please ask your administrator now.
SECTION I
Choose the ONE ANSWER that is closest to your situation - Mark on answer sheet:
01)Have you applied for a position with our company in the past?
A. YesB. No
IF 1 IS YES:
1a) How long ago did you apply for a position with our company?
A. Last weekD. About one year ago
B. About one month agoE. Over one year ago
C. About six months agoF. Can't remember
1b) Did you apply for the same position you are applying for now?
A. YesB. No
02)Are you working now?
A. No
B. Yes, but I don't like my job
C. Yes, but it doesn't pay enough
D. Yes, but I'm being laid off
E. Yes, but looking for a part time second job
F. Yes
03)When did you start work at your current (or last) position?
A. 0 - 2 months agoD. 1-3 years ago
B. 3 - 5 months agoE. Over 3 years ago
C. 6 - 11 months agoF. This will be my first job
04) Is it easy to steal merchandise/goods at your present (or last) job?
A. YesB. MaybeC. No
05)What has been your most recent monthly salary?
A. Less than $800D. $1,251-$1,700
B. $801 - $1,000E. Over $1,700
C. $1,001 - $1,250F. This will be my first job
06)When could you begin work at our company?.
A. TodayD. Two weeks
B. TomorrowE. One month
C. Next weekF. Don't know
07)Have you ever seen a customer shoplifting where you worked?
A. YesB. Can't RememberC. No
08)Have you been convicted of, or pled guilty to, a crime in the workplace, or related to the workplace, in the last 5 years that has not been expunged or completely stricken by the court?
A. YesB. Can't RememberC. No
IF 8 IS YES:
8a) The crime I was convicted of involved:
A. TheftC. Violence
B. FraudD. Other
8b) Did you spend time in jail (or prison) for your conviction?
A. YesB. No
IF 8b IS YES:
8c) How long were you in jail (or prison)?
A. Less than 1 monthD. 3 to 6 years
B. 1 month to 1 yearE. 6 to 10 years
C. 1 to 3 yearsF. Over 10 years
09)Have you observed other workers using illegal drugs on the job?
A. YesB. Can't RememberC. No
10)What type of relationship do you have with your supervisor in your present (or last) position?
A. PoorD. Excellent
B. FairE. No relationship
C. GoodF. This will be my first job.
11)Have you ever been fired?
A. YesB. Can't RememberC. No
IF 11 IS YES:
11a) What was the probable reason?
A. Poor work habits or performance
B. Excessive absences or tardiness
C. Conflict(s) with workers/supervisors
D. Dishonesty
E. Policy violation(s)
F. I need to explain it
12)Would your previous employers rehire you if you applied and a position was open?
A. YesC. I don't know
B. NoD. This will be my first job
13)At your present (or last) employer, did you know of workers who took unauthorized sick leave because they were using illegal drugs?
A. YesB. MaybeC. No
14)Have you ever worked for a supervisor who was stealing from your employer?
A. YesB. No
15)How many days of unauthorized absence from work have you had in the last 12 months?
A. NoneD .7 - 10 days
B. 1 - 3 daysE. Over 10 days
C. 4 - 6 daysF. This will be my first job
16)In your opinion, should employers be concerned about illegal drug use in the workplace?
A. YesB. MaybeC. No
17)How many times have you been late for work for any reason in the past year?
A. NoneD. 7 - 10 times
B. 1 - 3 timesE. Over 10 times
C. 4 - 6 timesF. This will be my first job
18)If you could add up the value of all the things you have stolen, the total would be:
A. Over $5,000D. $250 to $500G. $0
B. $1,000 to $5,000E. $100 to $250
C. $500 to $1,000F. Under $100
19)Have you observed other workers drinking alcohol on the job?
A. YesB. Can't RememberC. No
20)Does your present (or past) supervisor(s) let you complete and forward work without his/her final approval?
A. YesC. No
B. SometimesD. This will be my first job
21)On some occasions we may require you to work overtime for several hours on a moment's notice. Is this okay?
A. YesB. MaybeC. No
22)If required, would you be available to work on a night shift?
A. YesB. MaybeC. No
23)Are you on parole or under court-mandated probation?
A. YesB. Can't rememberC. No
24)How will your supervisor rate your performance on your present (or last) job?
A. PoorD. Excellent
B. FairE. Don't know
C. GoodF. This will be my first job
25) Is a person's dress and appearance at work important?
A. YesB. SometimesC. No
26)Have you ever supervised the work of others?
A. YesB. No
27)A party isn't a party without beer and liquor.
A. TrueB. False
28)Would you submit to a drug test for illegal drugs if it was company policy and you were requested to do so?
A. YesB. No
29)How have you handled the situation when you had problems with your supervisor where you worked?
A. Kept my thoughts to myself and kept working
B. Started looking for another job and kept working
C. Just ignored the situation and kept working
D. Confronted the supervisor and worked it out
E. Went to the supervisor's supervisor and told him/her about the problem
F. Never had a problem with a supervisor
30)Have you ever filed a medical claim even though you knew you were not sick or injured?
A. YesB. Can't RememberC. No
31)How much have you lost gambling in the last year?
A. Over $5,000D. $250 to $500G. $0
B. $1,000 to $5,000E. $100 to $250
C. $500 to $1,000F. Under $100
32)Which area do you need to improve as an employee?
A. Controlling my temperD. Work quality
B. AttendanceE. Other
C. TardinessF. This will be my first job
33)What DIDN'T you like about your last job?
A. Work HoursD. Supervisor
B. Pay PlanE. Location
C. Health InsuranceF. Don't know
34)Do you consider yourself the best at what you do at work?
A. YesB. No
35)How many times have you changed (moved) your residence in the past five years?
A. Over 10 timesD. 2 to 3 times
B. 7 to 10 timesE. 1 time
C. 4 to 6 timesF. None
36)Does having both men and women working together cause problems?
A. YesB. SometimesC. No
37)If a part time position is available, would you be willing to accept it?
A. Yes
B. Yes, if full time later
C. No, I need full time work now
38)Does using illegal drugs on the weekend affect a person's job during the week?
A. YesB .No
39)Do you know about other employees using company premises for unauthorized or illegal activities at your present (or last) place of employment?
A. YesB. No
40)What are the chances that you will move out of the area in the next year?
A. Very highB. MaybeC. Very low
41)Have you ever worked for another company in the same position you are applying for with this company?
A. YesB. No
42)Do you currently use any illegal drugs?
A. YesB. No
43)What was the reason for your leaving your last (or present) position?
A. I was asked to leaveD. Started school
B. I was laid offE. Personal reasons
C. To take another jobF. This will be my first job
44)In your present (or last) position did you have to fill out or complete detailed reports?
A. YesB. No
If 44 IS YES:
44a) Were you ever reprimanded for not filling out (or completing) the reports correctly?
A. YesB. No
END OF SECTION I
Copyright 2000. Testwrks, Incorporated., San Antonio, Texas Page 1
THE INSURE SURVEY
SECTION II
Statements about beliefs and attitudes concerning a variety of work-related subjects. Answer by choosing the number that best indicates your true opinion and writing that number on the answer sheet: Example:
Strongly Agree(1)
Agree(2)
Uncertain(3)
Disagree(4)
Strongly Disagree(5)
01)12345I work harder than most others in my department.
If you don't understand these instructions or have any other questions, please ask your administrator now.
Copyright 2000. Testwrks, Incorporated., San Antonio, Texas Page 1
SECTION II
Strongly Agree(1)
Agree(2)
Uncertain(3)
Disagree(4)
Strongly Disagree(5)
45)12345Most people's success depends more on luck than on their own skills.
46)12345It's best to tell your boss if you see another worker stealing.
47)12345Experimenting with drugs is okay if it isn't taken to extremes.
48)12345Some people can be too honest.
49) 12345If you have a good excuse, it's okay not to show up for work.
50)12345There are some things I don't like about myself.
51)12345It's best not to say anything if you know another worker is stealing.
52)12345TV and radio talk too much about the dangers of using cocaine or smoking marijuana.
53)12345The future looks very dark.
54)12345Companies buy insurance because they know their workers are going to steal from them.
55)12345If workers are caught stealing, the company should tell the police to arrest them.
56)12345If your manager cheats a customer it's all right for you to cheat the company.
57)12345There is never a good reason to take something that doesn't belong to you.
58)12345If you do too good a job you'll just be given more work than everyone else.
59)12345I have never wanted to buy things I couldn't afford.
60)12345Companies worry too much about illegal drug and alcohol use and not enough about really important things like training and worker's safety.
61)12345It's all right to take damaged things because insurance will pay the company for the loss.
62)12345If you can't figure out how to do something, it's best to just start something else.
63)12345It's all right to use illegal drugs as long as it doesn't affect how you do your job.
64)12345I have never made up an excuse to get out of doing something.
65)12345Sometimes a person has to cheat to make it in our society.
66)12345Someone who steals food to feed the family is not the same as a common thief.
67)12345Most of my problems are caused by other people's bad attitudes.
68)12345It's okay to tell a lie as long as no one gets hurt.
69)12345I liked every class I took in school.
70)12345If you intend to make up the time, your manager shouldn't be upset when you're late for work.
71)12345Using drugs like "Speed" to stay awake so you can get the job done is all right.
72)12345Companies expect too much work for the money they pay.
73)12345Once in a while, something I have said has been misunderstood by another worker.
74)12345It's not stealing to borrow tools from work which you plan to bring back.
75)12345It's all right to cheat someone who has cheated you.
76)12345Some of my past supervisors had it in for me.
77)12345If you work through your lunch break, you can leave work early.
78)12345Most people can do cocaine without getting addicted to it.
79)12345Selling illegal drugs to others isn't as bad as using them.
80)12345Buying something you know was stolen makes you a thief too.
81)12345Other people respect a person with lots of money, even if they know that person has gotten the money by breaking the law.
82)12345I have never done anything to upset another worker.
83)12345Smoking marijuana is about the same as drinking beer.
84)12345If another worker is stealing it's the company's problem and not any of my business.
85)12345Everybody will cheat and steal if they know they won't get caught.
86)12345Supervisors enjoy hassling their workers.
87)12345Not remembering what they did while they were drinking doesn't mean someone has a problem with alcohol.
88)12345You can't be both honest and successful.
89)12345Companies make too big a deal out of being late to work.
90)12345Employers expect their workers to steal from them, it's just human nature.
91)12345I have sometimes acted foolishly.
92)12345Sometimes I have the feeling that other people are using me.
93)12345Coming back late from lunch should be okay as long as your work is completed on time.
94)12345It's okay for a person to use marijuana to relax and do a better job.
95)12345If you were working in a restaurant, and your manager wasn't there, it would be okay to let your friends and family buy lunch at a lower price than everybody else.
96)12345If you're at work and just don't feel like working, it's okay to say you're sick and go home.
97)12345Selling illegal drugs is okay as long as you use the money to help poor people who are hungry.
98)12345Low wages force some workers to steal from their companies.
99)12345It's okay to take off work early if you've finished all your work.
100)12345Companies invade a person's privacy when they give drug tests.
101)12345Supervisors steal more from their companies than workers.
102)12345Taking something with the idea of paying for it later is not the same as stealing.
103)12345I've been really angry in the past.
104)12345Loyalty to a company is a thing of the past.
105)12345Making personal telephone calls at work without permission from a supervisor is no big deal as long as your work gets done on time.
106)12345Just because someone drinks till they pass out doesn't mean they have a drinking problem.
107)12345Lowering prices, without permission from a supervisor, is a good way to make more sales.
108)12345People like me have no power in our society.
109)12345Sloppy company security causes people to steal.
110)12345In a work situation it's best not to trust anyone.
111)12345Society forces some people to steal.
112)12345Do unto others before they do unto you.
113)12345I have some bad habits I need to break.
114)12345Life has been unkind to me.
115)12345A person doesn't have a drug problem if all he/she does is smoke marijuana on weekends.
116)12345Companies take the costs of stolen things off their taxes, so it really doesn't cost anybody money when things are stolen.
117)12345I have asked a friend to punch my time card when I knew I was going to be late for work.
118)12345It would bother me to work with someone I knew was stealing from the company.