Pre-Screening Questions for Employee S

Pre-screening Questions for Employee’s

(These questions must be completed before an employee fills out an application)

Name (First, Last, MI):

Street Address: Home Phone:

City/State/Zip: Cell Phone:

What type of position are you seeking?

Light Industrial/General Labor

Administrative/Clerical

Technical

Do you have a high school diploma or GED? yes no

Shift Preference: 1st 2nd 3rd Any

Will Travel Miles

Are you applying to the Ad in the newspaper? To which position are you applying for?

What is your experience level in the field that you are applying for?

Are you looking for a long term or short term position?

Will you be willing to work 1 day assignments or temporary assignments?

Can you provide documentation that verifies your eligibility to work in the USA? yes no

Are you 18 years of age? yes no

Drug testing may be required upon job offer – Please sign that you have read and understand this statement

Signature______

Please provide last 2 employment organizations, references and contact information:

Select Staff is pro-active in their job searches for their employees. Is there any other information that you would like to share with us at this time concerning your employment goals?

What would be a convenient time for you to come in and do an interview with us?

Notes (special skills or other information):

Please be aware, filling out this pre-screen is just as important as filling out an application, so please be neat, accurate, and complete!

We will expect to see you at the interview time that you have selected. If you cannot make your appointment, please give us the courtesy and call to let us know.

At that time we can set up another appointment for you if you choose. If you have any questions before your interview time please call us.

Thank you for choosing Select Staff and have a great day!

Qualifications Sheets Administrative (clerical, Legal and Medical), Call Center, Accounting and Light Industrial

Place a check mark in the boxes that you have work experience.

Administrative/ ClericalLegalLanguages Janitor

Administrative Assistant Briefs______ Labeling

Executive Assistant Discovery Production______ Landscaper

Cashier Draft Complaints Forms______ Laundry

Collating File papers at court______ Load/Unload

Correspondence Interrogatories andAccounting Machine Operator

Customer Service Responses DacEasy Machinist

Data Entry Clerk - Alpha/Num Law Library Great Plains Mason

Data Entry Clerk – Numeric Legal Assistant MS Money Financial Material Handler

Desktop Publishing Paralegal Quickbooks/Quicken Mill Operator

File Clerk Pleadings Peachtree Package (I-e UPS)

General Office Prepare Trail Exhibits Ross Painter

HR Professional Research Time Slips Pallet Jack

Instructor Title Timesheets Professional Picker/Packer

Mail Clerk Trademark______ Plastic Mold Injection

Microfiche/Microfilm Transcription Printer

Minutes______Accounting Skills Production Worker

ProofreaderMedical Accounts Payable ClerkSewer

Receptionist Billing Account Receivable Clerk Shipper/Receiver

Sales Data Entry Accountant Soldering

Secretary Medical File Clerk Accounting Manager Spot Welder

Switchboard Operator Medical Receptionist Analyst Stock

Trainer Medical Secretary 1 Auditor Tool/Die Maker

Transcriber Medical Secretary 2 Bank Teller Welder

Translator/Interpreter Medical Secretary 3 Billing Clerk______

Typist Medical Transcription BookkeeperCertifications and Licenses

Word Processor Office Management Bookkeeper Assistant Driver License – Class A

______ Records CPA Driver License – Class B

Typing Speed ______WPM Terminology Coding CFC

Shorthand Speed_____WPM Technician Collections Agent HVAC

Telephone Skills______ General Ledger/Balance Sheet Carpenter

1-3 Incoming Lines______ JD Edwards Electrician

4-8 Incoming LinesCall Center Payroll Clerk Forklift

9-15 Incoming LinesCustomer Service______ Machinist

16+ Incoming Lines Inbound Outbound Blend______ Mason

Dispatch ManagerLight Industrial Plumber

Executive Reception Supervisor Assembly Tool/Die

Intercom/Paging System Representative Automatic Labeling______

PBXCollections Automotive

Voicemail Systems Inbound Outbound Blend BinderyLifting Capability

______ Manager Blueprint 1-15 lbs

Office Equipment Supervisor CNC Operator 15-25 lbs

10-Key Representative Construction 25-50 lbs

Dictaphone Drafting Technician 50-100 lbs

CopierSkip Tracing DriverEquipment Owned

Fax Manager Driver’s Assistant Back Brace

PC Supervisor Electrician Ear Plugs

MAC Representative Electronic Assembly Eye Protection

Mainframe EPJ Driver Gloves

Scanners Telemarketing Forklift Operator Hard Hat

Tape Transcription Escalation/Issue Resolution Factory Worker Rubber Boots

______ Order Taking Tracking Food Service Small Hand Tools

______ General Labor Steel Toed Shoes

Inspector

InventoryMaintenance

Apartment

Factory Light

Factory Heavy

Preventative Auto

Auto

Qualification Sheets Technical (Software and Skills)

Word Processing MacGraphics NetworkTechnical Professional

Word – DOS MacPaint Nuclear Business Analyst

Word – Windows Power Point Pharmaceutical Database Administrator

Word – MAC Print Master Process Database Analyst

WordPerfect – DOS Publisher Procurement Database Designer

WordPerfect – Windows Quark Xpress Project Database Manager

AmIPro – DOS Visio Quality IT Management

AmIPro – DOS______ Safety Programmer/Analyst JR

______ Structural Programmer/Analyst SR

Programming Systems Systems Architect

Spreadsheets AutoCAD Test Technical Trainer

Excel – DOS Autodesk Textile______

Excel – Windows C++ Farming

Excel – MAC COBOLAssorted

Lotus - DOS Desktop PublisherTechnician Act

Lotus – Windows Developer Automation Architect

Quarttro Pro – DOS Fortran Biology Baan

Ouattro Pro – Windows FoxBASE Cable Beta Testing Operator

______ Graphic Designer Chemical Bio-Chemist

Internet/Web Master Civil Tech CAD

Databases Java Computer Chemist

Access NC Programmer Construction Consultant

Clarion Oracle (SQL) Electrical Email

DB2 PLC Programmer Engineering Hardware Purchasing

Dbase Paradox Environmental Internet

FoxBASE/Fox Pro Pascal Facilities Lawson

InformixSAS Programmer HVAC Meteorologist

InterBase Scientific Programmer Industrial MS Windows 3.1

Lotus Approach System Programmer Instrumentation MS Windows 95

Oracle UNIX Lab MS Windows 98

Paradox Unigraphics Drafter Maintenance MS Windows 2000

SQL Server Visual Basic Manufacturing MS Windows NT

Sybase______ QA (Quality Assurance) MS Windows XP

______ QC (Quality Control) Novell

Engineer Survey Oracle Financials

Civil Systems PeopleSoft

Graphics Design Technician Plan Perfect

Adobe FrameMaker Electrical Test Project

Adobe Illustrator Engineering Assistant Waste Management SAP

Adobe PageMaker Engineering Manager PC Support Tape Librarian

Adobe Photoshop Environmental Help Desk Timeline

Claris Draw Facilities Networking TurboProject

Corel Draw Industrial Technical SupportUnixWare

Digital Graphics Instrumentation Technical Writer WinFrame

Freelance Graphics LAN Telcom______

Harvard Graphics MS Certified Systems Computer Operator

HIJaak Graphics Suite ManufacturingIndustrial Sewing

Image Studio Mechanical

MacDraw

Reference Check Form

I authorize Select Staff to make any inquiry of or receive information from any person or organization regarding my suitability for employment and do hereby give permission to these persons or organizations to provide such information.

I understand that if I misrepresent or omit facts on my application that this is cause for dismissal from Select staff services if I have been employed.

I hereby release Select Staff and my previous employers from any and all liability for damages of whatever kind for providing information given regarding my employment history with their company.

I acknowledge that I have read and understand the statements above.

Date: ______Applicant signature: ______

Applicant printed name: ______

Notice of Lifting Capability

Some of our positions may require you to lift over 50 lbs.

If you are able to lift over 50 lbs. and are required by the Client Customer to do so, you must adhere to the company’s lifting policies, procedures and use the recommended equipment for lifting assist. If you are unable to lift 50 lbs and over without assistance, please let us know at time of interview so that we may place you in the proper position to best utilize you capabilities.

Date: ______Applicant signature: ______

Applicant printed name: ______

Version II Revised 12/8/11Page 1