Pre-screening Questionnaire
Evaluate your job eligibility
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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I am over 21 years old
*
Yes
Citizenship/Nationality
*
Is your country a native English speaking country?
*
Yes
No
If no, what is the official language of your country?
*
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Next
What is the highest level of education you have completed?
*
Please Select
Certificate
Associate Degree
Degree
Master's
Please specify the field of study for your highest degree
*
Please Select
Nursing
Education/Teaching
Carpentry
Welding
Business Management
Healthcare
Other
If other, please specify.
What school did you receive your training or degree from?
*
Does your degree or certificate have a number?
*
Yes
No
What is the degree or certificate number?
Do you have a professional license or certification related to your field of expertise?
If yes, please provide details of your license/certification.
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Do you currently hold a valid passport?
*
Please Select
Yes
No
Passport Number
*
Country of Issuance
*
Date of Issue
*
-
Month
-
Day
Year
Date
Date of Expiration
*
-
Month
-
Day
Year
Date
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Gender
*
Male
Female
Non-binary
Prefer not to say
What is your Ethnicity?
*
White British, Irish (other white backgroundsincluding, Gypsy or Irish traveller)
Mixed and multiple backgrounds, White and black Caribbean,White and black African white and black Asian, and other mixed or multiplebackgrounds.
Hispanic
South African
Chinese
Black African
Black Caribbean
Other backgrounds,(including any other Asian backgrounds, any other black backgrounds, Arab or any other ethnic group)
Have you ever applied for a U.S. visa before?
*
Please Select
Yes
No
Type of Visa Applied For?
Date of Application
-
Month
-
Day
Year
Date
Application Outcome
Please Select
Approve
Denied
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Do you have work experience in the United States?
*
Please Select
Yes
No
If yes, please specify the type of work and duration of employment.
Current employment status.
*
Please Select
Employed
Unemployed
Self-employed
Name of current employer (if employed).
*
Date of employment
*
-
Month
-
Day
Year
From
Date of employment
-
Month
-
Day
Year
To
Employer phone number,
*
Employer email address
*
Have you ever been convicted of a crime?
*
Please Select
Yes
No
If yes, please provide details of the conviction
Can you provide evidence of English language proficiency (e.g., TOEFL, IELTS scores)? (Yes/No)
*
Please Select
Yes
No
If yes, please provide details of your English language proficiency test scores.
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Upload Resume
*
Browse Files
Drag and drop files here
Choose a file
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Please upload a photo or scan of your photo ID (eg. driving license or passport)
*
Browse Files
Drag and drop files here
Choose a file
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Declarations
Please read the following Declarations carefully and select to agree.
You have correctly entered your own information for our employment verification checks
*
I agree
You have answered all the above questions accurately and truthfully
*
I agree
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Please verify that you are human
*
Submit
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