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Questionnaire

Applicant’s name
Interviewer’s name
Date

Question Answer Interviewer Notes

Please check the box that apply
 Asked me to repeat or rephrase the
Your Full Name : question
Address :  Answered with isolated words or small
Country phrases
Mobile Phone #(s)  Answered in complete sentences
Email:
 Asked me to repeat or rephrase the
* Are you willing to work question
?? Full Time  Answered with isolated words or small
?? Part Time phrases
?? Weekends  Answered in complete sentences
?? Holidays
 Asked me to repeat or rephrase the
* Did you have International Passport? question
If yes, what is your International Passport  Answered with isolated words or small
Number: phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
* Do you have a valid Driven License? question
Yes ?? No ??  Answered with isolated words or small
?? Class A phrases
?? Class B  Answered in complete sentences
?? Class C
 Asked me to repeat or rephrase the
* Are you married YES or No question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
What position are applying? question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
How many year’s working experience do question
you have  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
Briefly write about your working experience question
and how you will impact it in this reputable  Answered with isolated words or small
company and what new innovation can you phrases
bring into this company for positive growth  Answered in complete sentences
if employed.
 Asked me to repeat or rephrase the
Why do you want to work for our company? question
 Answered with isolated words or small
phrases
 Answered in complete sentences

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Describe a difficult situation you have been
in when responding to your call of duty.
How did you handle this?
What do you do when priorities change
quickly?
How much notice do you require before
leaving for a placement with your
company?
Have you traveled outside your country
before?
Do you have a valid US WORKING VISA
and Work Permit to travel down to United
STATES if finally you are employed to
work in this Company?
If you don’t have a valid US WORKING
VISA to resume work if employed, can you
procure VISA in your country or company
should refer you to registered US VISA
CONSULTANT that will assist you Visa
for resumption?
What skills have you acquired that would
help you carry on your responsibilities?
Please provide three references.
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
Page 2 of 4
  Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
question
 Answered with isolated words or small
phrases
 Answered in complete sentences

The remaining questions are to be completed by the interviewer

Poor Fair Good

Excellent

Please rate the Job Seekers: Appearance Excellent

Self Confidence Excellent

Attitude Good

Manners Excellent

Communication skills Good

English Rating Scale

1 – Uses few or no English words; understands greetings and other basic, memorized phrases.

2 – Uses some English phrases though thoughts may be disconnected; understands basic English sentences when spoken clearly and
slowly but relies on body language and facial expressions to determine meaning.

3 – Responds in complete thoughts and has a large vocabulary of everyday common terms. Can perform tasks based on a short series of
instructions, takes short time to mentally translate and can understand complex sentences when repeated or rephrased.

4 – Responds in complete sentences and can re-word what he/she is saying when the meaning is unclear or when he/she cannot remember
unusual vocabulary words. Can perform tasks based on complex instructions and understands others when they are speaking at a natural
rate.

5 – Responds completely with more descriptive language and does not take time to mentally translate when listening or speaking.
Understands conversations about abstract things.

Page 3 of 4
Based on the table above, please rate the applicant’s ability both to Rating: Native
speak and comprehend English. Briefly explain your decision.
Explanation:

This applicant will make a good staff workers for the following
reasons:

What difficulties will the applicant experience while placed

working in a foreign country?

Interviewer’s signature

Date

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