Sample Pre-screening Form Pre-Screening Tool, Services for XXXXXXXXXX Step 1 of 5 20% Position Date Day Month Year Candidate Name First Last Phone NumberLocation Email Address Duration Circumstances Communication Assessment and Availablility1. Why did you apply to work at XXXXXXXXXX?2. Availability/Flexibility[hours/shift work i.e. (day/eve/night/wkends) and/or (8, 10, 12 hour shifts)] Clinical Experience1. Please elaborate on your past experience and relevancy to the role you have applied for, including areas of clinical expertise and/or specialty in the past 7 years. (Service)2. Given your past experience, how would you plan your typical day for your patient care assignments(s) to meet patient care needs? (i.e. assess, plan, develop and implement action plans) Personal1. What personal values do you live by on a day to day basis, both in your personal and professional life?2. What would your current or previous manager(s) say is your greatest strength?3. In the workplace, what steps do you take when faced with a difficult/challenging situation (either personal or clinical)? [example of conflict resolution skills]4. Describe your technical abilities, experience and readiness to work in a high tech/fully digital clinical setting?5. Describe steps you have taken in your own professional development and self-improvement. Provide an example, i.e. any additional relevant courses/certifications taken. (Learning and Innovation) Final CommentsDo you have any comments?