Pre-Screen Interview Questionnaire

PRE-SCREEN INTERVIEW QUESTIONNAIRE

This questionnaire is used to gather information for initial screening of candidates for employment. Please answer all questions fully and accurately. False statements or omissions may disqualify an applicant or be grounds for termination if discovered after hire.

Personal Information

Full Legal Name:

Phone Number:     Email Address:

Position Information

Department:     Hiring Manager/Recruiter:

Available Start Date:     Salary Expectation:

Employment History (Most Recent First)

Job Title:     From:   To:

Job Title:     From:   To:

Education

Highest Degree Obtained:

Graduation Date:

Professional References

Phone:     Email:     Relationship:

Phone:     Email:     Relationship:

Phone:     Email:     Relationship:

Pre-Screen Questions

Are you legally authorized to work in this country? Yes No

Will you now or in the future require employer sponsorship for immigration status to continue employment? Yes No

Have you ever been convicted of a felony or misdemeanor that has not been expunged? Yes No

Are you able to perform the essential functions of the position with or without reasonable accommodation? Yes No

Are you willing to travel for the position if required? Yes No

Current Notice Period or Availability to Provide Notice:

Legal Disclosures and Authorizations

At-Will Employment: If hired, the employment relationship is at-will and may be terminated by either party at any time, with or without cause or notice, unless otherwise agreed in a written agreement signed by an authorized company representative.

Equal Opportunity: The employer is an equal opportunity employer and does not discriminate against applicants on the basis of protected characteristics under applicable law.

Background Check and Verification Authorization: I authorize the employer to verify the information provided on this form and to investigate my background, including, but not limited to, employment history, education, references, and criminal records, as permitted by applicable law. I understand that a conditional offer may be contingent upon satisfactory results of background checks and other pre-employment screenings.

Consent to Contact Previous Employers and References: I authorize the employer and its representatives to contact my previous employers, educational institutions, and references to obtain information relevant to my application and release those parties from any liability for providing such information.

I certify that all information provided in this Pre-Screen Interview Questionnaire is true, complete, and correct to the best of my knowledge. I understand that omission or misrepresentation of facts may result in rejection of my application or termination of employment if discovered after hire. I understand that this document is not an employment contract and does not alter the at-will nature of employment.

By signing below I acknowledge that I have read and understand the statements above and consent to the background checks and verifications described.

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