HIRE ASSISTHIRE SUCCESS®
EMPLOYMENT TESTING SYSTEM

HIRE ASSIST
PRE-EMPLOYMENT SURVEY
Accurate, Selective Survey, Integrity, Systems Table

For Authorized Use Only
A Valid Authorization Code Required For Use
For The Exclusive Use of Clients and Applicants of
HIRE SUCCESS®
11715 Fox Rd., Suite 400-227
Indianapolis, IN 46236
 Toll Free: 1-877-582-TEST (8378)
Outside U.S.: (317) 848-7980
* First Name: For the purposes of printing the text of the report (to print "he" or "she"), we need to know the gender of the person taking the test. This is the ONLY purpose for which this information is used.  The system does NOT use this information when evaluating the report.  Its use is only to know how to refer to the applicant in the printed report.
* Last Name:
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 Female
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* Company: 
* Position : 
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NOTE TO APPLICANT: This Report is used to measure Attitudes and Qualifications for Employment.  It is a means to let this employer get better acquainted with you.  The Company with whom you are interviewing is using this Survey as part of an overall interview program.  None of the answers you give on this Survey, standing alone, will be used to make a hiring decision.

PLEASE READ THE FOLLOWING
INSTRUCTIONS CAREFULLY

Answer All Questions Completely, Accurately and Honestly.
Any Questions not answered will be presumed to be a negative response, so be sure all questions are answered before Submitting the Survey using the Button at the end of the Questions.
Some Questions allow for Multiple responses, so please check all that apply when directed.
You are under no compulsion, legal or otherwise, to answer any of the questions in this Survey.

PLEASE ANSWER QUESTIONS AS THEY APPLY TO YOU IN THE PAST TEN (10) YEARS

BEGIN HERE
1. Did you, within the last ten years, cheat on a test at school? Yes
No
2. Have you, within the last ten years, cheated at cards? Yes
No
3. Have you, within the last ten years, switched price tags on merchandise in a store, so that you could purchase an item at a lower cost? Yes
No
4. Have you, within the last ten years, taken merchandise from a store without paying for it? Yes
No
5. Have you, within the last ten years, aided a friend in stealing? Yes
No
6. If you were at work and you saw a customer stealing, what would you do

a. Approach and accuse the customer
b. Tell your boss
c. Call the police
d. Say nothing - would not want to get involved

 A
B
C
D
7. Do you think that everyone sometime in their life will steal? Yes
No
8. Have you only taken money when you were in need? 
(Select N/A if you have never taken money and this doesn't apply)		 Yes
No
N/A
9. Have you only taken merchandise when you were in need?
(Select N/A if you have never taken any merchandise and this doesn't apply)		 Yes
No
N/A
10. Do you believe that most people are basically honest? Yes
No
11. If you are at a check out register and the cashier gives you back too much money, do you:

a. Tell her she gave you back too much.
b. Consider yourself lucky and keep the money.

 A
B
12. How much would you say you spent on alcoholic beverages the past week? $
13. Have you taken any illegal drugs in the last three (3) weeks? Yes
No
14. If so, what kind?
15. Have you smoked Marijuana in the past three (3) weeks? Yes
No
16. If you caught your child shoplifting, what would you do?
17. State your opinion on the proper punishment that should occur if an employee gets caught stealing:
18. How much money, all added up, would you guess that you have taken over the last 10 years?
      $
19. How much money have you, within the last ten years, taken from a previous employer? $
20. How much merchandise have you taken from previous employers? $
21. How much would you guess that you have shoplifted?  $
22. Do you believe that most employers expect too much from their employees? Yes
No
23. Have you, within the last ten years, received unauthorized discounts from your friends at their place of employment? Yes
No
24. Does it ever make you angry when a supervisor repeatedly tells you what to do? Yes
No
25. Have you, within the last ten years, knowingly purchased “HOT” or stolen merchandise? Yes
No
26. If so, why?
27. Have you, within the last ten years, received unauthorized free merchandise from friends at their work? Yes
No
28. If you are given this job, do you think that you may, at some time, be tempted to steal from your employer? Yes
No
29. What alcoholic beverages do you like to drink best?
30. Do you know of anyone who smokes marijuana while they are at their place of employment? Yes
No
31. If you were offered one, would you smoke marijuana on your break or on your lunch/dinner hour? Yes
No
32. Name the type of illegal drugs that you have tried before.
33. What percentage of people would you estimate, are regular users of illegal drugs? %
34. What percentage of people would you estimate, are regular marijuana users? %
35. What would you do if you caught someone stealing from you?
36. Do you have any gambling debts? Yes
No
37. Do you have a good credit rating? Yes
No
38. Do you AGREE with the statement: "Everybody steals a little from time to time, but it doesn’t do any harm." Yes
No
39. If you were in a position to judge a person for stealing $100.00 in cash money, would you make them:

a. Repay the money
b. Give them a good talking to.
c. Just let the whole thing go this time.
d. Or find out if they had a valid reason to steal the money

 A
B
C
D
40. Do employees steal from their employers because:

a. They are not paid enough
b. The company has so much money, they won’t miss it
c. They are dishonest.

 A
B
C
41. Have you, within the last ten years, improperly, or without the knowledge and/or permission of your employer, given merchandise away to your friends? Yes
No
42.Have you written a bad check within the past ten years? Yes
No
43. Have you, within the last ten years, given your friends unauthorized discounts at your place of work? Yes
No
44. How many times have you shoplifted in the last ten years? 
45. What percentage of people do you believe steal from their employers? 
46. Have you, within the last ten years, been in a rehabilitation program for the use of alcohol or drugs?
(Having been in a rehabilitation program will not disqualify you from employment.)		 Yes
No
47. If “yes”, explain:
48. Do you drink: (check all that apply)

a. Only on weekends
b. In the afternoons
c. At lunch time
d. In the evening
e. In the morning
f. Only Socially
g. Never

 A
B
C
D
E
F
G
49. Do you spend more than $20 for liquor each week? Yes
No
50. Have you, within the last ten years, been fired for drinking on the job? Yes
No
51. Do you gamble? Yes
No
52. Do you spend more than $10 each week gambling? Yes
No
53. Have you, within the last ten years, tried any other type drugs other than those prescribed by your physician?  (Do not include over-the-counter drugs and medications) Yes
No
54. Do you feel that most of the time you have been treated unfairly at work by the management? Yes
No
55. Have you, within the last ten years, had anyone else at work punch your time card for you? Yes
No
56. Have you, within the last ten years, damaged someone else’s property because:

a. You were getting even
b. You were just a kid, and it was fun
c. Never did

 A
B
C
57. Have you, within the last ten years, improperly, or without the knowledge and/or permission of your employer, given away merchandise or given discounts to your friends when you were on the job? Yes
No
58. Do you think it is easy to get away with stealing? Yes
No
59. Would you say that most employers were overbearing towards their employees? Yes
No
60. Do you think it is alright at times to steal cigarettes, soft drinks, lunch money and small items such as these from your work.? Yes
No
61. All totaled, how much cash money have you taken in the last 10 years?  $
62. Has another person, within the last ten years, tried to get you to steal with them? Yes
No
63. If all totaled, how much in merchandise have you taken in the last 10 years?  $
64. Have you, within the last ten years, stolen anything just to see if you could do it? Yes
No
65. If you found a wallet with someone’s I.D. and $100 in it, would you:

a. Call this person and return it
b. Pocket the $100.00 and throw the wallet away

 A
B
66. Is it important to you to be right most of the time? Yes
No
67. How long have you lived in this state? 
68. Do you ever lie to get your way? Yes
No
69. If you saw one of your co-workers stealing, what would you do?
70. Have you, within the last ten years, sold illegal drugs? Yes
No
71. Have you, within the last ten years, been convicted of a felony?
(Having been convicted of a felony will not necessarily disqualify you from employment.)		 Yes
No
72. Have you, within the last ten years, been convicted of shoplifting?
(Having been convicted of shoplifting will not necessarily disqualify you from employment.)		 Yes
No
73. Have you, within the last ten years, been on probation or parole?
(Having been been on probation or parole will not necessarily disqualify you from employment.)		 Yes
No
74. Do you have a valid drivers license for this state? Yes
No
75. Have you, within the last ten years, taken any merchandise from work without paying for it? Yes
No
76. Have you, within the last ten years, taken money from work? Yes
No
77. Have you, within the last ten years, been involved with a friend to take money from your place of work? Yes
No
78. Have you, within the last ten years, been involved with a friend to take merchandise from your place of work? Yes
No
79. Have you, within the last ten years, been caught stealing? Yes
No
80. Do you feel that if an employee is not being treated fairly or paid enough, that they have good reason to steal? Yes
No
81. Were you, within the last ten years, fired for stealing? Yes
No
82. Are there any personal problems that you feel might interfere with your job duties? Yes
No
83. If so, explain:
84. Have you, within the last ten years, had problems with your supervisors, managers or employers? Yes
No
85. If so, explain:
86. What percentage of the people do you feel will answer these questions truthfully?
87. Have you, within the last ten years, been in a physical fight with someone at work? (If "Yes", please explain:)
 Yes
No
88. Do you have any friends that use illeal drugs?

a. A few
b. Most of them
c. None

 A
B
C
89. Have you, within the last ten years, tried or experimented with any of these drugs?: (Check All That Apply)

a. Hash
b. Acid
c. Opium
d. Smack
e. Uppers
f. Cocaine
g. Downers
h. None

 A
B
C
D
E
F
G
H
90. If you have used marijuana, which of the following best describe your use:
  (Check All That Apply)

a. Once a week
b. Once a day
c. After work
d. At parties
e. Tried it only one time
f. Never

 A
B
C
D
E
F
91. Do you know a person who has stolen from his employer? Yes
No
92. Have you, within the last ten years, taken merchandise from a store without paying for it? Yes
No
93. Do you believe it is human nature for a person to try to beat the system? Yes
No
94. Have you, within the last ten years, taken something and felt bad after you have done it?
(Select N/A if you have never taken anything and this doesn't apply.)		 Yes
No
N/A
95. Do you believe that everyone has a little dishonesty in them? Yes
No
96. Do you think that everyone has shoplifted at least once in their life? Yes
No
97. Have you, within the last ten years, tried to short change customers for your own gain? Yes
No
98. Have you, within the last ten years, improperly, or without the knowledge and/or permission of your employer, traded discounts with a friend from your employment and theirs? Yes
No
99. Do you think if a person is underpaid by his employer, it is okay to steal? Yes
No
100. Have you, within the last ten years, refunded stolen merchandise at a store? Yes
No
101. Have you stolen, only small things, because you had a good reason? Yes
No
102. Have you, within the last ten years, been so angry with a co-worker that you exploded and told him/her off? Yes
No
103. Have you tried marijuana? Yes
No
104. Have you, within the last ten years, sold marijuana? Yes
No
105. Have you, within the last ten years, written a check knowing you did not have enough money in the bank to cover it? Yes
No
106. Have you, within the last ten years, falsified any reports from a pervious employer? Yes
No
107. Is you drivers license

a. Valid
b. Suspended
c. Revoked

 A
B
C
108. Do you think an employee should be fired for stealing? Yes
No
109. If no, why not?
110. Have you, within the last ten years, threatened to hurt anyone at work? Yes
No
111. If yes, explain
112. Describe the things that makes you most angry at work?
END OF SURVEY
WHEN YOU ARE SATISFIED THAT ALL QUESTIONS HAVE BEEN ANSWERED ACCURATELY AND HONESTLY, PLEASE READ THE INFORMATION BELOW, THEN PRESS THE BUTTON TO SUBMIT THIS FORM FOR PROCESSING.
THANK YOU FOR COMPLETING THE HIRE ASSIST PRE-EMPLOYMENT SURVEY

 
BY SUBMITTING THIS FORM, YOU AGREE TO THE FOLLOWING:
I hereby authorize the company to whom I am applying for employment to 
investigate the accuracy of the information submitted on this survey.
I hereby release all persons and organizations from all claims and liabilities
of any nature arising from such investigation of information given.
I understand that all hiring decisions are made by the employer to whom I have applied,
and for whom I am completing this Survey Form.  Neither the test developer, nor any of its
employees, licensees, representatives, agents or affiliates are responsible for the final hiring decision.

IF YOU AGREE:
 

 

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STRICTLY CONFIDENTIAL

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HIRE SUCCESS®

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(Within the United States)
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or
 (317) 848-7980

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