Pre-employment/Independent Contractor Questionnaire

	If you are interested in working as a home-based employee or independent contractor, please complete my Pre-employment/Independent Contractor Questionnaire below to give me a better idea of your qualifications. Name: Address: City, State, Zip Phone: E-mail: Are you seeking full or part-time work Full-time    Part-time Would you prefer to work as an employee or independent contractor (IC)? Employee    Independent Contractor Line Rate Charge (IC) or Expectation (employee): cents per line (65 characters/line) If you are interested in full-time employment, what benefits are you seeking? What days of the week would you prefer to work? What hours would you prefer to work? What is your career goal for the next 5 years? Skills What is your typing speed? wpm Please list the computer programs are you comfortable using: Affilitations/Certifications Are you an AAMT member? Yes No Are you a CMT? Yes No Equipment Availability Do you own a foot pedal? Yes No What type of internet connection do you have? Dial-up DSL Cable Satellite Other If other, please describe here. Education Please list your education. Work Experience Please list any transcription work experience you may have. How did you hear about Office Wizard? Thank you for completing our questionnaire! Upon submission and review of your answers, if we feel you may be a qualified candidate, we will contact you to take an online skills test.

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