MAUDE RESTAURANT: 212 S Beverly Dr, Beverly Hills, CA 90212, United States

JobInterviewQuestion
naire

Applicant’s name
Interviewer’s name
Date

Question Answer Interviewer Notes

Please check the box that apply
 Asked me to repeat or rephrase the
Why do you want to work in U.S? question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
What would you need in order to enjoy your question
time in the U.S?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
Describe your plans for the future. What question
are your goals?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
Describe your general health. question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
Have you ever suffered from or sought question
treatment for depression, alcoholism, drug  Answered with isolated words or small
addiction or an eating disorder? Please phrases
explain.  Answered in complete sentences
 Asked me to repeat or rephrase the
Has anyone in your family suffered from question
depression or alcoholism? Please explain.  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
Describe any history of Job abuse in any question
company you have previously worked?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
Describe where you were born and raised question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the

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 JobInterviewQuestion
naire
Do you have any siblings? If so, how old question
are they?  Answered with isolated words or small
phrases
 Answered in complete sentences

 Asked me to repeat or rephrase the

Describe the relationship you have with question
your siblings.  Answered with isolated words or small
phrases
 Answered in complete sentences

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  Asked me to repeat or rephrase the
How often do you have contact with your question
family members?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
Describe your family’s support of your question
decision to work in U.S.  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
What is your family’s reaction to you question
spending a year away from home?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
How were you disciplined as a child? question
 Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
When, where and for how long have you question
spent time away from home?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
When, where and for how long have you question
traveled in English-speaking countries?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
Are you willing to be placed with a question
Company that is of a different religion?  Answered with isolated words or small
How would you accommodate? phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
What is your favorite area of study? Why question
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 about it?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
Where and when did you complete any question
formal English courses?  Answered with isolated words or small
phrases
 Answered in complete sentences
 Asked me to repeat or rephrase the
What volunteer work have you done? question
 Answered with isolated words or small
phrases
 Answered in complete sentences

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

The remaining questions are to be completed by the interviewer

Please rate the Job Seekers:

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.

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

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

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