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What is your gender?

Male

Female

What is your marital status?

What is your favorite hobby or interest?

What is your age?

What is the highest level of education you have achieved?

Less than high school degree

High school degree or equivalent (e.g. GED)

Some college but no degree

Associate degree (e.g. AA, AS)

Bachelor's degree (e.g. BA, AB, BS)

Master's degree (e.g. MA, MS, MBA)

Professional degree (e.g. MD, DDS, JD)

Doctorate degree (e.g. PhD)

Please describe your current residence:

Owned by you or someone in household with a mortgage or loan

Owned by you or someone in household free and clear (no mortgage or loan)

Rented

Occupied without payment of rent

Which of the following categories best describes the industry you work in?

How long have you used our products?

Less than 6 months

6 months to less than 1 year

1 year to less than 3 years

3 years to less than 5 years

5 years or more

How frequently do you purchase from us?

How would you rate your level of satisfaction with us?

What are your reasons for joining our company? (Check all that apply)

Unemployed and needed a job

Referred by a friend

Fringe benefits

Reputation as a good place to work

Career advancement

Salary advancement

Other

How well do you believe your manager lives by your company's ethic?

Extremely well

Very well

Sometimes does, sometimes doesn't

Not very well

Doesn't abide by philosophy at all

If you have ever offered suggestions to management, how satisfied were you with the response?

Never offered a suggestion

Not at all satisfied

Not very satisfied

Somewhat satisfied

Very satisfied

Which of the following best describes the department you work in?