Connie Koerth
(920) 864-7708
Toll-Free (866) 848-7708
Fax (920) 864-7707

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?	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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