Worker Survey Oregon WIOA Response Instructions: Please complete the following information. All information in this survey is confidential and will be used to help the WIOA Rapid Response Teams provide the services that best meet the needs of all employees. Employer Name: Job Title: Employer Address: How many years have you worked for this employer? Layoff Date: Hourly wage: Do you belong to a union? No Yes Full or Part-time: If yes, please list the union name/local #: What city and zip code do you live in: Are you a veteran or the spouse of a veteran? City: Zip Code: No Yes Are you the only wage earner in your What is your education level: (check the highest you have household? earned) Less than High School/GED Community College Yes No degree What is your age range: High School/GED completion Bachelor’s Degree 16-24 25-35 36-54 55+ Vocational or Trade Certificate Master’s Degree or higher Do you need additional language or accommodations? Please list: I have already lined up a replacement job: Yes If yes, when is your start date: Future Career Plans: (check all that apply) I want to return to work as quickly as possible with the skills that I have I need to upgrade my skills before I look for my next job I need help deciding my future career/training plans I am interested in these services: I am interested to talk with someone about: (check all that apply) (check all that apply) Exploring Careers Determining my transferable skills Job Search Assessments and Skill Development Resume Development Skill Development to address gaps, develop new skills Basic Computer Skills Work-Based Learning such as On-the-Job Training, Interviewing Skills Apprenticeships, and Work Experience Job Applications Pell Grants and Community College training Networking and Social Media for Job Search Services for Veterans and veteran spouses Updating skills in math, reading, writing WorkSource Center services and help to find a job I am interested in these services: Do you want someone to follow up with you? (check all that apply) Yes No Information on financial support If Yes, Name: Information on dealing with job loss Please provide your preferred method of contact Information on dealing with stress Phone: Transportation, Child Care or Housing Email: resources Text:
Worker Survey Instructions: Please complete the following information. All information in this survey is confidential and will be used to help the WIOA Rapid Response Teams provide the services that best meet the needs of all employees. Oregon WIOA Response Employer Name: Job Title: Employer Address: How many years have you worked for this employer? Layoff Date: Hourly wage: Full or Part-time: Do you belong to a union? No Yes If yes, please list the union name/local #: What city and zip code do you live in: City: Zip Code: Are you a veteran or the spouse of a veteran? No Yes Are you the only wage earner in your household? Yes No What is your age range: 16-24 25-35 36-54 55+ What is your education level: (check the highest you have earned) Less than High School/GED Community College degree High School/GED completion Bachelor’s Degree Vocational or Trade Certificate Master’s Degree or higher Do you need additional language or accommodations? Please list: I have already lined up a replacement job: Yes If yes, when is your start date: Future Career Plans: (check all that apply) I want to return to work as quickly as possible with the skills that I have I need to upgrade my skills before I look for my next job I need help deciding my future career/training plans I am interested in these services: (check all that apply) Exploring Careers Job Search Resume Development Basic Computer Skills Interviewing Skills Job Applications Networking and Social Media for Job Search Updating skills in math, reading, writing I am interested to talk with someone about: (check all that apply) Determining my transferable skills Assessments and Skill Development Skill Development to address gaps, develop new skills Work-Based Learning such as On-the-Job Training, Apprenticeships, and Work Experience Pell Grants and Community College training Services for Veterans and veteran spouses WorkSource Center services and help to find a job I am interested in these services: (check all that apply) Information on financial support Information on dealing with job loss Information on dealing with stress Transportation, Child Care or Housing resources Do you want someone to follow up with you? Yes No If Yes, Name: Please provide your preferred method of contact Phone: Email: Text:
Worker%20Survey%20-%20from%202018%20Guide.docx