Jacobson Agency Candidate Assessment

Candidate Assessment Form
Name:

First NameLast Name
Phone Number:
Format: (000) 000-0000.
E-mail Address:
example@example.com
Location

Street

Street Address Line 2

CityState

Zip Code
How did you hear about us?
(referred by..., online ad, Facebook, etc.)
Where would you rate your interest regarding the position?

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Why?
What appeals to you most about a possible career with us?
Based on past accomplishments, what gives you the confidence you would do well with us?
Of these, what are the three most important factors in your next career?
When we contact your previous employer, what will they say regarding your work ethic and attitude?
Are there any limitations with your schedule regarding your availability to work?
If yes, please explain:
Are there any issues in your past that would appear on a Background Check?
If yes, please explain:
Do you have a valid driver's license and a reliable vehicle?
Please list any additional questions you may have. We can address these during our next meeting.
Resume upload

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Should be Empty:

Candidate Assessment Form