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1. What is your gender?
 
Male
 
Female
 
 
 
2. What is your marital status?
 
Single (Never married)
 
Married
 
Domestic partnership
 
Widowed
 
Divorced
 
Separated
 
Don’t know
 
 
 
3. 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)
 
 
 
4. Which of the following categories best describes the industry you work in?
 
Automotive
 
Advertising
 
Consulting Services
 
Education
 
Entertainment
 
Financial Services
 
Government Services
 
Healthcare
 
Human Resources
 
Information Technology
 
Marketing/Sales
 
Non-Profit
 
Pharmaceuticals
 
Public Relations
 
Technical Services
 
Travel
 
Other
 
 
 
5. Which category best describes your annual income?
 
Under $15,000
 
$15,000 - $29,999
 
$30,000 - $44,999
 
$45,000 - $59,999
 
$60,000 - $74,999
 
$75,000 - $89,999
 
$90,000 - $104,999
 
$105,000 - $119,999
 
$120,000 or more
 
Prefer not to answer
 
 
 
6. 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
 
 
 
7. What is your job function?
 
Non-supervisory Staff
 
Supervisor
 
Functional Manager
 
Department Manager
 
Senior Management/Director/Vice President
 
Senior Executive/Chief Officer/Executive Vice President
 
 
 
8. Overall, how satisfied are you with the company you work for?
 
Extremely Dissatisfied
 
Very Dissatisfied
 
Neither Satisfied nor Dissatisfied
 
Very Satisfied
 
Extremely Satisfied
 
 
 
9. How long have you worked at company?
 
Less than 6 months
 
6 months - 1 year
 
1-2 years
 
3-5 years
 
More than 5 years
 
 
 
10. Overall how satisfied are you with your position at this company?
 
Very dissatisfied
 
Somewhat dissatisfied
 
Not satisfied or dissatisfied
 
Somewhat Satisfied
 
Very satisfied
 
 
 
11. Do you feel that employees are recognized as individuals?
 
Always
 
Usually
 
Sometimes
 
Rarely
 
Never
 
Not sure
 
 
 
12. How flexible is the company with respect to your family responsibilities?
 
Very inflexible
 
Somewhat inflexible
 
Neither
 
Somewhat flexible
 
Very flexible
 
 
 
13. Have you ever observed or experienced any of the following forms of discrimination or harassment at this company?
 
Racial discrimination
 
Sexual harassment
 
Age discrimination
 
Gender discrimination
 
Sexual orientation discrimination
 
No, none of the above have been observed or experienced

 
 
 
14. I receive enough opportunity to interact with other employees on a formal level.
 
Strongly disagree
 
Somewhat disagree
 
Neither agree nor disagree
 
Somewhat agree
 
Strongly agree
 
 
 
15. I have a clear path for career advancement?
 
Strongly disagree
 
Somewhat disagree
 
Neither agree nor disagree
 
Somewhat agree
 
Strongly agree
 
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