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When was the last time you had a Job?
 
You currently have a Job
 
1-6 months ago
 
6-12 months ago
 
1-2 years ago
 
2-4 years ago
 
4+ years ago
 
 
 
How many people are you supporting?
 
Just yourself
 
1-2 people (besides yourself)
 
3-5 people (besides yourself)
 
6+ people (besides yourself)
 
 
 
How many hours a week do you work?
 
1-10 hours
 
11-20
 
21-30
 
31-40
 
41-50
 
50+
 
 
 
What level of education have you achieved?
 
High school (or GED)
 
Two Year College
 
Four Year College or University
 
Trade School
 
None
 
Other
 
 
 
 
what is the longest length of time you have held a job
 
Less then 6 months
 
6-12 months
 
1-2 years
 
2-3 years
 
3-5 years
 
5+ years
 
 
 
Have you work in any of the fields listed bellow?
 
Agriculture
 
Shipping
 
Storage
 
Finance
 
Human resources
 
Accounting
 
Sales
 
Plumbing
 
Electrician
 
Other
 

 
 
 
If you had an opportunity to work in any of the above fields as a part time employee would you?
 
Yes
 
No
 
Other
 
 
 
 
Would you be willing to be compensated for you work in....
 
Fresh Healthy meals 3 times a day
 
Hot shower
 
Location to do laundry
 
Location to safely store Items (clothes, electronics, personal items)
 
Money
 
A bed to sleep in

 
 
 
How many hours a week would you be willing to work?
 
10-20 hours
 
20-30 hours
 
30-40 hours
 
40+ hours
 
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