Pre‑Hire Safety Questionnaire Form Pre Hire Questionnaire 1 "*" indicates required fields Name* First Last City*State*Email* Are you authorized to work in the US and do you have a valid driver's license?* Yes No Are you currently pursuing Safety Certifications/Degrees OR have you provided Safety Support in a “Titled” Safety Professional role?* Yes No You do not meet the criteria to continue.This field is hidden when viewing the formHow many years of experience do you have in the construction industry working as a titled Safety Professional, and at what level? Safety Director Regional Safety Manager Senior Safety Professional Field Safety Professional Entry Level / Intern Other Specify OtherYearsPlease enter a number greater than or equal to 0.Years as Safety DirectorPlease enter a number greater than or equal to 0.Years as Regional Safety ManagerPlease enter a number greater than or equal to 0.Years as Senior Safety ProfessionalPlease enter a number greater than or equal to 0.Years as Field Safety ProfessionalPlease enter a number greater than or equal to 0.Years as Entry Level / InternPlease enter a number greater than or equal to 0.Have you obtained an Associate or Bachelor’s Degree in Occupational Safety / Environmental / Health? Yes No Other Are you certified through OSHA? Check all that apply, (we require copies of certificates accompany your application): OSHA 10-Hour (Construction/General Industry) OSHA 30-Hour (Construction/General Industry) OSHA 500/501/510/511 (Authorized Trainer) Certified Safety & Health Official (CSHO) Specialist in Safety & Health (SSH) Other Certificates Drop files here or Select files Max. file size: 50 MB. Do you have any Board of Certified Safety Professionals (BCSP) certifications or other you have obtained? Check all that apply, and attach copies of certificates: Certified Safety Professional (CSP) Associate Safety Professional (ASP) Construction Health and Safety Technician (CHST) Safety Management Specialist (SMS) Occupational Hygiene and Safety Technician (OHST) Certified Instructional Trainer (CIT) Other Certificates Drop files here or Select files Max. file size: 50 MB. Do you have First Aid / CPR / AED Certification? Attach copies of certificate Drop files here or Select files Max. file size: 50 MB. Are you within commuting distance of the position?* Yes No Are you willing to travel if needed? Yes No Please check any experience with the following: Accident and Investigation reporting Personal Protective Equipment Safety Training Safety Talks / Toolbox talks Creating Policy and Procedure requirements Lock-Out Tag-Out Confined Space Creating and implementing Safe Job Procedures? CV / Resume*Max. file size: 50 MB.
