Applicant’s Full Name:
Present Contact Address:
Passport Number:
Marital Status:
Contact Telephone:
Post / Position Offered:
Job Reference #:
Contact Email Address:
Nationality:
Question
Why do you want to work in USA?
What would you need in order to
enjoy your time in the USA?
Describe your plans for the future.
What are your goals?
Describe your general health.
Have you ever suffered from or
sought treatment for depression,
alcoholism, drug addiction or an
eating disorder? Please explain.
Ramendra Vikram Tripathi
Gaur Cascade, I Block Flat Number 1475, RajNagar Extension Ghaziabad India
In Process
Married
+91 8810586352
Quality Analyst (Software Testing)
Ramendrav.tripathi@gmail.com
Indian
Answer
Sir,
Having global exposure tremendously
helps to broaden my skills and enhances
my ability to work across cultures. So I
believe this opportunity will definitely
help to advance my career.
Sir,
Actually I need a cool working
atmosphere, without any feud or riots of
any kind. Beside this I need opportunities
to learn more and more about any
aspects of the creation. Especially in my
field.
Sir,
My plan for the future is to become an
entrepreneur and own a IT company. To
achieve this goal, I want to work in more
Sir,
As per doctor recent diagnosis I am
physically, mentally and emotionally fit. I
have no genetic disorder, neither current
nor in my past. Overall I can say I have no
physical, mental and emotional illness for
any kind right now.
Sir,
I have never suffered from any
depression, alcoholism, drug addiction or
eating disorder. I have never undergone
sought treatment.
Interviewer Notes
Please check the box that apply
 Asked me to repeat or rephrase the
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Has anyone in your family suffered
from depression or alcoholism?
Please explain.
Describe any history of Job abuse in
any company you have previously
worked?
Describe where you were born and
raised
Do you have any siblings? If so, how
old are they?
Describe the relationship you have
with your siblings.
How often do you have contact with
your family members?
Describe your family’s support of
your decision to work in USA.
What is your family’s reaction to you
spending a year away from home?
How were you disciplined as a child?
When, where and for how long have
you spent time away from home?
When, where and for how long have
you traveled in English-speaking
countries?
Sir,
Like me none of my family has suffered
from depression or alcolhlism.
. question
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  Asked me to repeat or rephrase the
Are you willing to be placed with a question
Company that is of a different  Answered with isolated words or small
religion? How would you phrases
accommodate?  Answered in complete sentences
 Asked me to repeat or rephrase the
What is your favorite area of study? question
Why do you like it?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
What did you like about your last Job question
experience? What did you dislike  Answered with isolated words or small
about it? phrases
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Where and when did you complete question
any formal English courses?  Answered with isolated words or small
phrases
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What volunteer work have you question
done?  Answered with isolated words or small
phrases
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 Asked me to repeat or rephrase the

How will you adjust to a new question
company, country and culture?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
How much notice do you require question
before leaving for a placement with  Answered with isolated words or small
your company? phrases
 Answered in complete sentences
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What problems do you anticipate question
while working in your previous job?  Answered with isolated words or small
phrases
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 Asked me to repeat or rephrase the
How do you feel about being placed question
with a Company of a different race  Answered with isolated words or small
or has different political views or phrases
beliefs?  Answered in complete sentences

The remaining questions are to be completed by the interviewer

Poor Fair Good Excellent

Please rate the Job Seekers: Appearance Excellent

Self Confidence Excellent

Attitude Good

Manners Excellent
 Communication skills Good

English Rating Scale

1 – Uses few or no English words; understands greetings and other basic, memorized phrases.

2 – Uses some English phrases though thoughts may be disconnected; understands basic English sentences when spoken clearly
and slowly but relies on body language and facial expressions to determine meaning.

3 – Responds in complete thoughts and has a large vocabulary of everyday common terms. Can perform tasks based on a short
series of instructions, takes short time to mentally translate and can understand complex sentences when repeated or
rephrased.

4 – Responds in complete sentences and can re-word what he/she is saying when the meaning is unclear or when he/she cannot
remember unusual vocabulary words. Can perform tasks based on complex instructions and understands others when they are
speaking at a natural rate.

5 – Responds completely with more descriptive language and does not take time to mentally translate when listening or
speaking. Understands conversations about abstract things.

Based on the table above, please rate the applicant’s Rating: Native
ability both to speak and comprehend English. Briefly
explain your decision. Explanation:

This applicant will make a good staff workers for the

following reasons:

What difficulties will the applicant experience while

placed working in a foreign country?

Interviewer’s signature

Date