IPS Action Centre Needs Assessment

Personal Information

This information is confidential. Personal information will not be given out. It will be used by the Action Centre to help plan adjustment programs and will not be tied to the individual. If you would rather not answer a question, just move on to the next one.

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* 1. Personal Information

First Name

Last Name

Telephone #

E-mail Address:

Workplace:

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* 2. Age:

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* 3. Please list any language other than English that you understand and check the boxes to indicate your skills in the language:

Speak

Read

Write

Work Profile

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* 4. Your last job (please check all that apply):

Production worker

Servicing

Inspection

Material handler

Hospitality

Clerical

Skilled Trades (which trade?)

Other (please specify)

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* 5. How long were you employed with your last employer?

0 - 5 years

6 - 10 years

11 - 15 years

Over 15 years

Action Centre Feedback

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* 6. Do you have plans for the next 3-6 months following the layoff?

Yes

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* 7. If so, what are your plans?

Retraining

Looking for work

Retiring

Job already arranged

Self-employment

Other (please specify)

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* 8. Are you interested in retraining or upgrading your skills?

Yes

If yes, do you know what training or upgrading you are interested in pursuing? Please specify.

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* 9. Are you considering self-employment?

Yes

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* 10. Are you willing to commute or relocate to a new job?

Within Greater Toronto Area

Anywhere in Ontario

Anywhere within Canada

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* 11. What are your hourly wage requirements? (select one)

Minimum wage - $20

$21 - $25

$26 - $30

Over $30

Your Education and Training

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* 12. What is the highest level of education completed?

Less than Grade 12

High School Diploma (or GED)

Community or Career College

University Degree

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* 13. Are you currently enrolled in any education or training program?

Yes

If yes, please specify course and institution:

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* 14. Please check the boxes to describe your English skills:


Speak	Speak menu
Read	Read menu
Write	Write menu

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* 15. Please check the box to describe your Math skills:

Basic

Intermediate

Advanced

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* 16. Please check boxes below to describe your present computer skills in each area:


Using email, internet	Using email, internet menu
Word processing (Microsoft Word)	Word processing (Microsoft Word) menu
Spreadsheet (Excel, 1-2-3, etc.)	Spreadsheet (Excel, 1-2-3, etc.) menu

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* 17. Please indicate the education and training information you would be interested in having:

Educational upgrading and job retraining funding programs

Apprenticeships

Resources for improving basic reading, writing, math skills

Getting a high school diploma or equivalency (GED)

Community college / university programs

Career College (trucking, heavy equipment, culinary, welding, etc.)

Skills Course: CNC machining, blueprint reading, welding (which course?)

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* 18. Please indicate any supports that would be of interest to you:

Resume preparation workshop

Job search workshop

Job interview workshop

Job Finders Club (meeting informally with co-workers)

Labour market information workshop

EI workshop

Career planning workshop

One-on-one career counseling

Educational upgrading and re-training opportunities and funding workshop

Budgeting and financial planning workshop

First Aid course

Social events and meetings to stay connected with co-workers

IPS Action Centre Needs Assessment

Personal Information

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* 1. Personal Information

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* 2. Age:

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* 3. Please list any language other than English that you understand and check the boxes to indicate your skills in the language:

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* 4. Your last job (please check all that apply):

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* 5. How long were you employed with your last employer?

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* 6. Do you have plans for the next 3-6 months following the layoff?

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* 7. If so, what are your plans?

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* 8. Are you interested in retraining or upgrading your skills?

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* 9. Are you considering self-employment?

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* 10. Are you willing to commute or relocate to a new job?

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* 11. What are your hourly wage requirements? (select one)

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* 12. What is the highest level of education completed?

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* 13. Are you currently enrolled in any education or training program?

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* 14. Please check the boxes to describe your English skills:

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* 15. Please check the box to describe your Math skills:

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* 16. Please check boxes below to describe your present computer skills in each area:

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* 17. Please indicate the education and training information you would be interested in having:

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* 18. Please indicate any supports that would be of interest to you:

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* 19. Thank you for completing this questionnaire. We would value any additional comments or suggestions you may have.