Work Experience USA - Placement Program

Interviewer's Report

Applicant Name:

Winter 2015

CCUSA ID:
Availability Dates
What are the university break dates on the applicant's school proof?

Start:

Using these dates as a guide, what are the applicant's availabilty dates?

Start:

Availability dates must be the same or less than their break dates AND the approved State
Department dates for the country. They must indicate the dates the applicant is willing to work.

End:
End:
dd/mm/yyyy

dd/mm/yyyy

Interview Questions
What qualities (strengths, talents, skills) does the applicant have that will set them apart from other employees?

Describe any challenges he/she experienced in a past job or academic setting. How were these challenges resolved?

Does he/she work out or play sports? If Yes, how often?

Is he/she willing to work manually? (e.g. heavy lifting, pushing, stopping heavy objects)

Yes

No

If No, please explain:

Is he/she physically fit to do jobs that require strength or stamina?

Yes

No

If No, please explain:

Evaluation of Job Positions
After you have evaluated the English level and reviewed with the applicant the Position part of the Position/Skills Addendum, please choose 3 of the job positions that the
participant will choose to evaluate.

Position 1:

Position 2:

Position 3:

English Competency Evaluation

N/A indicates person is a native English Speaker. Employers, please refer to your Work Experience USA Competency Guide.

English Speaking Ability:

N/A

English Comprehension:

N/A

Communication:

Interviewer's Name:

Date:

Applicant's phone no: (011)

Email:
(country code) (city code) number

Best time/hour to call applicant (time range in applicant's local time):

Employers: We encourage you to call the applicant at home to request additional information, but remember the time difference!
Los Angeles

9 am

Lima

11 am

Submit To CCUSA

New York
Bogata

Buenos Aires
Rio de Janerio

London

Amsterdam
Frankfurt

Helsinki
Johannesburg

Moscow

Bangkok

Perth

Adelaide

Sydney

Auckland

12 noon

1 pm

5 pm

6 pm

7 pm

8 pm

12 am

1 am

2:30 am

3 am

5 am

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