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Questions marked with an * are required Exit Survey
 
Confidential Contact Information
* First Name : 
* Lastname
 : 
Address Line 1 : 
Address Line 2 : 
City : 
    State     Zipcode
* Cell Phone : 
* Email
 : 
 
 
 
* Company Name
   
 
 
 
* Job Classification (i.e. what do you do for the company)
   
 
 
 
What issue(s) are most important to you that you would like to improve? (select all that apply)
 
Better Wages
 
Better Health Care
 
More Fairness
 
Pay Equity
 
Rights on the Job
 
Better Safety
 
A Standard Workweek
 
Better Retirement Options
 
Cost of Living Adjustments
 
More Paid Holidays
 
Childcare Options
 
Better Overtime Policy
 
Reduce Favoritism
 
Better Vacation Policy
 
Better Job Security
 
A Profit Sharing Plan
 
Seniority Rules
 
ALL OF THE ABOVE!
 
Other
 

 
 
 
How did you hear about us?
 
Billboard
 
Bus Sign
 
Aquasox Game
 
Friend
 
Other