Pre-Screening Assessment Sheet
Pre-Screening Assessment Sheet
I. Pre-Screening Assessment Overview
The purpose of this Pre-Screening Assessment Sheet is to gather essential information to determine your eligibility for the specified role, program, service, or event. By filling out this assessment, you provide us with the necessary details to proceed with the next steps in the selection process.
Prepared by: [YOUR NAME]
Email: [YOUR EMAIL]
II. Personal Information
Please provide your basic personal details for identification and communication purposes.
|
Field |
Information |
|---|---|
|
Full Name |
Salvador Green |
|
Date of Birth |
May 15, 1990 |
|
Address |
Scottsdale, AZ 85250 |
|
Email Address |
salvador@you.mail |
|
Phone Number |
222 555 7777 |
|
Preferred Contact Method |
|
III. Employment or Educational Background
Please provide your employment history or educational qualifications relevant to the opportunity.
|
Field |
Information |
|---|---|
|
Most Recent Job Title |
Software Engineer |
|
Company Name |
OmniTrick |
|
Employment Dates |
January 10, 2022 – Present |
|
Relevant Degree/Cert |
Bachelor’s in Computer Science, JoliVent University |
|
Graduation Year |
May 2020 |
IV. Eligibility Criteria
Please answer the following questions to determine your eligibility for the program/position.
|
Field |
Information |
|---|---|
|
Are you legally eligible to work in the United States? |
Yes |
|
Do you have a minimum of 3 years of experience in the related field? |
Yes |
|
Do you meet the minimum GPA or academic requirements for the program? |
Yes |
V. Health and Medical Information (If Applicable)
This section is only relevant if you are applying for a medical program, clinical trial, or similar service.
|
Field |
Information |
|---|---|
|
Do you have any allergies? |
No |
|
Are you currently under any medical treatments? |
No |
|
Are you taking any prescription medications? |
Yes |
VI. Additional Qualifications and Skills
Please list any additional qualifications, certifications, or skills that may be relevant to the position, program, or service.
|
Qualification/Skill |
Details |
|---|---|
|
Certification |
Certified Software Developer, ForBiz Organization |
|
Skill |
Python programming, JavaScript, Data Analysis |
VII. Availability and Commitment
Please confirm your availability and commitment level to participate in the program, role, or event.
|
Field |
Information |
|---|---|
|
Available Start Date |
June 15, 2050 |
|
Full-Time Availability |
Yes |
|
Weekly Hours Commitment |
40 hours/week |
VIII. Consent and Declaration
By completing this assessment, you consent to the use of your information as part of the screening process. If any information is found to be false or misleading, it may result in disqualification.
I hereby declare that all information provided above is true to the best of my knowledge.
November 30, 2050
