Select the occupation that best represents the job you were laid off:

Transcription

1 Page 1 Last date or expected last date of work: Select the occupation that best represents the job you were laid off: a. Architecture and Engineering Occupations b. Arts, Design, Entertainment, Sports and Media Occupations c. Building and Grounds Cleaning and Maintenance Occupations d. Business and Finance Operations Occupations e. Community and Social Service Occupations f. Computer and Mathematical Occupations g. Construction and Extraction Occupations h. Education, Training, and Library Occupations i. Farming, Fishing, and Forestry Occupations j. Food Preparation and Service Related Occupations k. Healthcare Practitioners and Technical Occupations l. Healthcare Support Occupations m. Installation, Maintenance, and Repair Occupations n. Legal Occupations o. Life, Physical, and Social Science Occupations p. Management Occupations q. Military Specific Occupations r. Office and Administrative Occupations s. Personal Care and Service Occupations t. Production Occupations u. Protective Service Occupations What was your pay wage before taxes: How frequently were the above wages paid out? a. Hourly b. Weekly c. Bi-Weekly d. Monthly e. Annually How many hours a week did you work? How many full years of service do you have with the company?

2 What is your highest level of education completed? a. 0 (zero) b. 1 c. 2 d. 3 e. 4 f. 5 g. 6 h. 7 i. 8 j. H.S. Freshman k. H.S. Sophomore l. H.S. Junior m. H.S. Senior - Attained H.S. Diploma n. College Freshman o. College Sophomore p. College Junior q. Bachelor s Degree r. Masters s. Doctorate t. GED u. H.S. Senior - Did Not Attain H.S. Diploma v. Attained Certificate of Attendance/Completion w. Attained Other Post-Secondary (Post-High School) Degree or Certificate x. Associate Degree Do you have a trade/vocational certificate or licensure? Page 2 What are your future employment plans? a. Already have a job lined up b. Seek employment, same field c. Seek employment, new field d. Retrain for a new career e. Plan to retire f. Start my own business g. Relocate to a new area

3 h. Leave the workforce i. Other plans Please select up to three (3) occupation groups that best fit your desired job type: a. Management b. Business and Financial Operations c. Computer and Mathematical d. Architecture and Engineering e. Life, Physical, and Social Services f. Legal g. Education, Training, and Library h. Arts, Design, Entertainment, Sports, and Media i. Healthcare Practitioners and Technical j. Healthcare Support k. Protective Service l. Food Preparation and Serving Related m. Building and Grounds Cleaning and Maintenance n. Personal Care and Service o. Sales and Related p. Office and Administrative Support q. Farming, Fishing, and Forestry r. Construction and Extraction s. Installation, Maintenance, and Repair t. Production u. Transportation and Material Moving v. Military Specific How many miles would you be willing to commute one way for employment? a b c d e f. 50+ Would you be willing to relocate for employment? Page 3 What would you like assistance with? Please select at least one:

4 a. Writing a Resume b. Labor Market Information c. Interviewing Skills d. Job/Career Counseling e. Job Placement Assistance f. Relocation Assistance g. Transportation Assistance h. Child Care i. Financial Counseling j. No Assistance with the Above Options Would you be interested in additional training? Please select at least one: a. English as a Second Language (ESL) b. Basic/Remedial Education c. GED d. Trade/Vocational e. Professional Certification/Credential f. On-the-Job Training g. Academic h. Entrepreneurial Training i. Other Retraining j. Not Interested Where do you look to find employment opportunities? Please select at least one: a. Illinois JobLink b. Illinois worknet c. Newspapers d. Online Job Boards e. Social Media f. Family/Friends g. Other Methods Please identify the Social Media site(s) that you use: a. Facebook b. Twitter c. LinkedIn d. YouTube e. Pinterest f. Other g. None (I don t have one)

5 Page 4 Would you like someone from a local office to contact you with further recovery information? If yes, the survey taker enters: First Name* Last Name* (Must provide phone or ) Phone Number Gender a. Male b. Female Date of Birth Veteran