Intake Survey

Please complete the below information.

The following intake survey helps us measure the effectiveness of the LifeWorks Program and our ability to help you in your career journey. This survey will be your initial benchmark and we will continue to ask you how you're progressing and where you need support.

Your responses are only used for data analysis to help us ensure this class remains funded and free for future participants. Your answers will never be shared with any outside agencies.

Please use the same name and email as you entered on your application for the LifeWorks program. This ensures your responses are connected to your records in a timely manner.

Estimated Time to Complete: 5 Minutes

Contact Information

First Name

Last Name

Email

example@example.com

Phone Number

Demographic Information

Gender

Marital Status

County

If Other, enter the County you live in.

Do you have a disability?

YesNo

If Yes (to have a disability), explain.

Race

Ethnicity

Have you ever served in the U.S. military?

Are you a single parent?

Including yourself, how many people currently live in your household?

If Other (to assistance received), please enter additional detail.

What is the highest level of education you have completed?

Current Employment Information

Are you currently employed?

Is your current primary job full time or part time?

Please search for your employer's name in the list below. If your employer is not listed, please select "Other Employer" from the list and input your employer's name in the "Other Employer Name" field.

What is the name of your primary employer?

Other Employer Name

Primary Employer Account ID

What is your position title for your current primary job?

How many jobs do you currently work?

How many hours do you work per week at your primary job?

How many hours do you work per week at your second job?

How many hours do you work per week at your third job?

How many total hours do you work in a week at ALL of your job(s)?

What is the hourly wage at your primary job?

What is the hourly wage at your second job?

What is the hourly wage at your third job?

What is your INDIVIDUAL monthly income?

What benefits are available to you at your current primary job? (Check all that apply.)

Health benefitsRetirement benefitsNo benefits

Job Search Information

Are you currently job searching?

In your job search, are you seeking a full time or part time position?

Choose the following ways that you have tried to job search until now. (Select all that apply.)

If Other (to job search methods), please enter additional detail.

How do you feel in your job search on a daily basis?

Choose the top three reasons that be describe why you are currently unemployed.

If Other (to reasons unemployed), please enter additional detail.

What reasons best describe why you are not currently getting the job search results you are expecting? (Select all that apply.)

I am getting good job search results I need better job search strategiesMy resume/cover letter needs more workEmployers are not reaching out to me for interviewsI am not hearing back from employers after interviewsI have personal matters that I need to address firstI have not had time to job search properlyI am taking classes and not yet searching

How confident do you feel in your ability to get the job/career you desire?

Of the following items, identify up to three areas of growth you would like to have in your job search.

If Other (to job search growth areas), enter additional detail.

Skills Training Prior to Starting LifeWorks

For the purposes of this survey, we define Skills Training as any certification or class that makes you more employable or marketable.

Have you enrolled in a skills training program prior to starting LifeWorks?

Please search for your school's name in the list below. If your school is not listed, please select "Other School" from the list and input your school's name in the "Other School Name" field.

At what school did you enroll in skills training?

School ID

Other School Name

What skills training program did you enroll in?

When did you start the skills training program?

Did you complete your training program?

Did/Will you earn one or more industry certifications from your training program?

If yes (to earned one or more certificates), provide the certification name(s).

Would you be interested in learning more about career and technical education programs?

Current Employment Quality Information

How often do you feel anger and/or frustration at your job?

How often do you feel fulfillment and/or joy at your job?

At your current job, how often do you feel your unique skills are being used?

How often have you felt stressed?

How satisfied are you with your current employment situation?

If Other (to current employment satisfaction), please enter additional detail.

How likely are you to be at your current job five years from now?

If someone were to ask you the reason why you work at your current job, which of the following reasons would be the biggest for you? (Select all that apply.)

If Other (to reasons for working your current job), please enter additional detail.

Work Barriers and JP Experience

Which one of the following statements best describes your goal for your Jobs Partnership experience?

I hope to use my Jobs Partnership experience to land a job as soon as possible.I want to use my Jobs Partnership experience to find a better paying job within my same field of work.I want to use my Jobs Partnership experience to help find a new career but do not anticipate getting additional education or training.I want to use my Jobs Partnership experience to find a new job or career and will strongly consider getting additional education or training.

Which of the following statements describe your attitude towards your current work situation? (Select all that apply.)

I am frustrated that I can't find a better paying job based upon my current education and skills.I am frustrated in my current job that I cannot progress to a higher level of pay.I am frustrated that I can't figure out a path to a better job or career.I am open to pursuing a number of different jobs or careers.I have a specific job or career in mind that I would like to figure out how to pursue.

Which one of the following statements best describes your support network?

I feel like I am alone in figuring out how to improve my job situation.I feel like I have a little support in figuring out how to improve my job situation.I feel I have considerable support in figuring out how to improve my job situation.

Hidden Fields

Semester

Survey Type

Program Salesforce Record ID