SCREENING ASSESSMENT FORM Interviewee’s name : Sex : Applied position : Department : PART A I - CANDIDATE SCREENING Personal Documents Job Application Resume Health certificate Certificates / Degree ID Card + Permanent Resident Book Picture Termination Decision II Experiences related to applied position Position: Position: Position: Position: IV Relatives in company Name: Name: Name: V Salary 13 Qualified Unqualified Remark Company From To Position Department Relationship Current Expected Negotiated Salary PART B - R&T’S SCREENING ASSESSMENT Assessment Qualified for interview Blacklist check R&T’s signature: Potential for other positions Unqualified Yes No Other comments TS-ART-FO-011 R0