#0000000 for SAMPLE PERSON on 2005/11/07

iSCORE Test

CONTENTS	Page

Test Results	2
Application	3

#BEJCCG8D
2005/11/07

Name:	SAMPLE PERSON
Telephone:	416-746-0444
Email:
Requested By:	2

iSCOREsolutions	Test Results

OVERALL RECOMMENDATION

PROCEED WITH EXTREME CAUTION
PROCEED WITH CAUTION
PROCEED

TYPE OF TEST	SECTION	SCORE
Math/Accuracy Evaluation	Numerical Accuracy	2.5 / 3
	Posting Accuracy	2 / 4
	Math	4 / 6
	Alphanumeric Accuracy	0.75 / 1
Light Industrial	Mailroom	3 / 3
	Shipping/Receiving	3 / 3
	Stockroom	2 / 3
Visual Shipping & Receiving		14 / 16
Spelling		9 / 10
Reading Comprehension		8 / 10
TOTAL		48.25 / 59

APPLICATION FOR EMPLOYMENT

PRE-EMPLOYMENT QUESTIONNAIRE
EQUAL OPPORTUNITY EMPLOYER

PERSONAL INFORMATION

NAME (LASTNAME, FIRSTNAME)*

PRESENT ADDRESS

CITY

PROVINCE

POST CODE

PERMANENT ADDRESS

CITY

PROVINCE

POST CODE

PHONE NO.*

CELL/ALTERNATE NO.

ARE YOU LEGALLY ELIGIBLE TO WORK IN CANADA?*	YES NO
DO YOU HAVE A VALID WORK PERMIT?*	YES NO
HAVE YOU EVER BEEN CONVICTED OF A CRIME FOR WHICH YOU HAVE NOT BEEN PARDONED?*	YES NO

EDUCATION HISTORY

SCHOOL/GED	NAME	#YEARS ATTENDED	DID YOU GRADUATE?	SUBJECTS STUDIED
GRAMMAR SCHOOL			YES NO
HIGH SCHOOL			YES NO
COLLEGE			YES NO
TRADE, BUSINESS OR CORRESPONDENCE SCHOOL			YES NO

EMPLOYMENT INFORMATION

POSITION APPLYING FOR*

AVAILABLE FOR
FULL TIME PART TIME

SALARY EXPECTED

HOW DID YOU HEAR ABOUT OUR COMPANY?

IF YOU SELECTED OTHER:

PLEASE INDICATE THE DAYS AND HOURS YOU ARE AVAILABLE TO WORK*

Please list earliest start time available and latest end time (if you are available any time write 'open'). If you cannot work a regular 8-hour shift, please indicate the maximum number of hours you can work each day.
	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
From
To

PLEASE INDICATE LENGTH OF EXPERIENCE (YEARS/MONTHS)

WAREHOUSE	FORKLIFT	SEMI-SKILLED	SKILLED
Unloading/Loading	Counter Balance	Brake Press	Arc Welding
Order Picking	Reach	Punch Press	Mig Welding
Packaging	Cherry Picker	Milling	Tig Welding
Shipping/Receiving	Clamp	Lathe	Maint. Mechanic
Assembly	Pallet Rider	CNC	Millwirght Mechanic
Sorting	Walkie		Engineer
Other	Other	Other	Other

HOW MANY POUNDS CAN YOU LIFT?
10lbs 20-30lbs 40-50lbs 50-60lbs 60+lbs

SAFETY EQUIPMENT (Please check what you own):
Safety Boots Safety Glasses Safety Gloves Other

FORMER EMPLOYERS (LIST BELOW LAST FOUR EMPLOYERS STARTING WITH THE LAST ONE FIRST)

Date (Month & Year)
From	Name & Phone Number of Employer	Pay	Position	Reason for Leaving
To	Name & Phone Number of Employer	Pay	Supervisor	Telephone
From	Name & Phone Number of Employer	Pay	Position	Reason for Leaving
To	Name & Phone Number of Employer	Pay	Supervisor	Telephone
From	Name & Phone Number of Employer	Pay	Position	Reason for Leaving
To	Name & Phone Number of Employer	Pay	Supervisor	Telephone
From	Name & Phone Number of Employer	Pay	Position	Reason for Leaving
To	Name & Phone Number of Employer	Pay	Supervisor	Telephone

REFERENCES (THREE PROFESSIONAL REFERENCES NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR)

NAME	TEL.	BUSINESS	POSITION	YEARS KNOWN

PHYSICAL DEMANDS SELF-EVALUATION FORM

Your safety is very important to us! We would like to establish what job functions you are comfortable performing. Please indicate the maximum amount of each activity that you feel you can perform safely and comfortably.
EXAMPLES:
Standing: if you could stand a maximum of 50% of your workday, you would select 'S' for 'Sometimes', as it covers approximately half of your day.
Lifting - Heavy II (Greater than 30kgs/65lbs): If you could not lift the weight indicated, as part of your duties, then you would select 'N' for 'Never.'
LEGEND:
    Yes (51% and above)
    Sometimes (up to 50% of the time)
    Never

Physical Requirements	Y	S	N	Details/Comments
General:
Sitting
Standing
Walking
Kneeling/stooping/crouching
Climbing stairs/ladders/catwalks
Repetitive bending
Repetitive finger movement
Repetitive hand movement
Repetitive wrist movement
Reaching forward
Reaching overhead
Colour vision: Distinguishing shades/colours
Lifting:
Heavy II (30kgs/65lbs or more)
Heavy I (18-30kgs/41-65lbs)
Moderate II (11-18kgs/26-40lbs)
Moderate I (5-11kgs/11-25lbs)
Light (5kgs/10lbs or less)
Carrying/Pushing/Pulling:
Carrying I (1-9kgs/1-20lbs)
Carrying II (10-18kgskgs/21-40lbs)
Pushing I (1-9kgs/1-20lbs)
Pushing II (10-18kgskgs/21-40lbs)
Pulling I (1-9kgs/1-20lbs)
Pulling II (10-18kgs/21-40lbs)
Environmental Conditions:
Heights
Cold
Heat
Dry
Dust
Working Alone
Working as a Team
Other (Please Explain):

AUTHORIZATION

"I certify that all information provided in this application is accurate and complete to the best of my knowledge, and I understand that intentionally providing false information could result in the refusal of employment or discharge. I also authorize the employers, schools, organizations, or persons named above to provide information regarding my employment, education, character, and qualifications. I understand that I will not directly approach any of iSCOREsolutions Clients for work whether temporary or permanent in nature. After registration if I wish to pursue a permanent, full or part-time positions with any of iSCOREsolutions Clients I will only do so adhering to iSCOREsolutions Policies and Prodedures."