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Accurate Staffing
Pre-Screen Questionnaire

*All fields required

First Name:
Last Name:
Address:
City: State: Zip:
Phone:
E-mail:
Are you at least 18 years of age? Yes No
Do you have the legal right to work in the United States? Yes No
How did you hear about Accurate Staffing?
What job do you qualify for?
Are you willing to take a drug test? Yes No
Have you ever been convicted of a crime involving theft, violence, drugs, or fraud?
If Misdemeanor or Felony, please state year.
Are you interested in Full Time/Part Time/Temp-to-Hire work? F/T P/T T-H
What shifts can you work? 1st 2nd 3rd
What shift would you prefer to work? 1st 2nd 3rd
Will you accept short-term assignments?
(varies from one day to long term) 		Yes No
Minimum hourly rate?
(do not state open or negotiable)		$/hour
Do you have reliable transportation?
If yes, what do you use?		 Yes No
Car Bus Ride