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Would you consider your company to be an open minded company when it comes to hiring people who may have a disability (Down Syndrome, physically impaired, sight impaired etc.)
 
Yes
 
No
 
Depends
 
Choose to not answer
 
 
 
 
 
What is the nature of your business?
   
 
 
 
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
 
 
 
Do you feel that employees are recognized as individuals?
 
Always
 
Usually
 
Sometimes
 
Rarely
 
Never
 
Not sure
 
 
 
How flexible is the company with respect to your family responsibilities?
 
Very inflexible
 
Somewhat inflexible
 
Neither
 
Somewhat flexible
 
Very flexible
 
 
 
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

 
 
 
What accommodations are you able or willing to make for an individual you have hired?
   
 
 
 
What position do your find yourself needing to fill?
 
Janitorial
 
Cashier
 
Supervisory
 
Other_____________________________
 
 
 
Describe what you or your company is looking for in any individual you want to work for your company.
   
 
 
 
What training/education do you wish your potential employees would have prior to your hiring them?
   
 
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