Employment Survey
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1. First Name and email address please

First Name and email address please First Name
Email Address

2. Please complete below:

Please complete below: Age
Sex
Marital Status (M,S,D)
# Dependents
State
City/ Town
# Yrs Education
If College What Degree?
# Yrs worked in Specialty

3. Employment Status (Select one)

Employment Status (Select one) Employed Happily (like job/pay, etc)

Employed, but UnderEmployed (job less than your skill level)

Employed, but Frustrated (can't stand job anymore)

Self Employed & Satisfied

Self Employed & Frustrated (it's not working, long hours, low pay, no benefits)

Unemployed

4. If Unemployed answer questions below, otherwise skip to question #5

If Unemployed answer questions below, otherwise skip to question #5 How Long Have You been Un-employed (Months)
What Industry Laid you Off?
How long Employed prior to lay off? (Yrs)
Did you Receive Unemployment Benefits/Severance from company?
If you Received Unemployment benefits, for how long? (Months)

5. What is your current income or income when you were working full time?

What is your current income or income when you were working full time? Less than $50,000

$50,000-75,000

$75,000-100,000

$100,000-150,000

$150,000-200,000

$200,000-300,000

Over $300,000

6. What are your most pressing issues? Please rate each question

	Critical	Very Important	Somewhat Important	Not Important
Lack of current income to pay bills and provide for family	What are your most pressing issues? Please rate each question Lack of current income to pay bills and provide for family Critical	Lack of current income to pay bills and provide for family Very Important	Lack of current income to pay bills and provide for family Somewhat Important	Lack of current income to pay bills and provide for family Not Important
No accumulated savings to draw from or savings gone	No accumulated savings to draw from or savings gone Critical	No accumulated savings to draw from or savings gone Very Important	No accumulated savings to draw from or savings gone Somewhat Important	No accumulated savings to draw from or savings gone Not Important
Lack of benefits (healthcare, sick leave, paid vacation	Lack of benefits (healthcare, sick leave, paid vacation Critical	Lack of benefits (healthcare, sick leave, paid vacation Very Important	Lack of benefits (healthcare, sick leave, paid vacation Somewhat Important	Lack of benefits (healthcare, sick leave, paid vacation Not Important
Inability to accumulate wealth or wealth has evaporated	Inability to accumulate wealth or wealth has evaporated Critical	Inability to accumulate wealth or wealth has evaporated Very Important	Inability to accumulate wealth or wealth has evaporated Somewhat Important	Inability to accumulate wealth or wealth has evaporated Not Important
Inability to retire ( no pension, 401K to support retirement without working	Inability to retire ( no pension, 401K to support retirement without working Critical	Inability to retire ( no pension, 401K to support retirement without working Very Important	Inability to retire ( no pension, 401K to support retirement without working Somewhat Important	Inability to retire ( no pension, 401K to support retirement without working Not Important
Don’t see the future improving (pay, benefits, promotions)	Don’t see the future improving (pay, benefits, promotions) Critical	Don’t see the future improving (pay, benefits, promotions) Very Important	Don’t see the future improving (pay, benefits, promotions) Somewhat Important	Don’t see the future improving (pay, benefits, promotions) Not Important

7. What Options Have You Considered? Rank in order of importance.

	Best Choice	2nd Choice	3rd Choice	4th Choice	Last Choice
Get a better job	What Options Have You Considered? Rank in order of importance. Get a better job Best Choice	Get a better job 2nd Choice	Get a better job 3rd Choice	Get a better job 4th Choice	Get a better job Last Choice
Accept short term engagements to bring in some money	Accept short term engagements to bring in some money Best Choice	Accept short term engagements to bring in some money 2nd Choice	Accept short term engagements to bring in some money 3rd Choice	Accept short term engagements to bring in some money 4th Choice	Accept short term engagements to bring in some money Last Choice
Change Industries	Change Industries Best Choice	Change Industries 2nd Choice	Change Industries 3rd Choice	Change Industries 4th Choice	Change Industries Last Choice
Go back to school to train for new job/career	Go back to school to train for new job/career Best Choice	Go back to school to train for new job/career 2nd Choice	Go back to school to train for new job/career 3rd Choice	Go back to school to train for new job/career 4th Choice	Go back to school to train for new job/career Last Choice
Self Employment or Start own Business	Self Employment or Start own Business Best Choice	Self Employment or Start own Business 2nd Choice	Self Employment or Start own Business 3rd Choice	Self Employment or Start own Business 4th Choice	Self Employment or Start own Business Last Choice

8. If You were to choose Self Employment, which issues would apply? Check all that apply and note Most Important at bottom

If You were to choose Self Employment, which issues would apply? Check all that apply and note Most Important at bottom Knowing where to look to find a suitable business

Knowing how to start a business

Having money to start business

Having training or education to start & run a business

Have a mentor to guide me to success

Concern/fear that business would fail

Most Important

9. What Types of Businesses would Interest you the Most? Select and add comment at bottom.

	Very Interested	Somewhat Interested	Not the Least Interested
Real Estate Investing requiring little money down	What Types of Businesses would Interest you the Most? Select and add comment at bottom. Real Estate Investing requiring little money down Very Interested	Real Estate Investing requiring little money down Somewhat Interested	Real Estate Investing requiring little money down Not the Least Interested
Internet Marketing of products or services	Internet Marketing of products or services Very Interested	Internet Marketing of products or services Somewhat Interested	Internet Marketing of products or services Not the Least Interested
Stock Market Investing	Stock Market Investing Very Interested	Stock Market Investing Somewhat Interested	Stock Market Investing Not the Least Interested
Multilevel Marketing (Health & Beauty, Fitness, Energy, Travel or cellphone services)	Multilevel Marketing (Health & Beauty, Fitness, Energy, Travel or cellphone services) Very Interested	Multilevel Marketing (Health & Beauty, Fitness, Energy, Travel or cellphone services) Somewhat Interested	Multilevel Marketing (Health & Beauty, Fitness, Energy, Travel or cellphone services) Not the Least Interested
Franchising (fast food, business consulting services, cleaning services, others)	Franchising (fast food, business consulting services, cleaning services, others) Very Interested	Franchising (fast food, business consulting services, cleaning services, others) Somewhat Interested	Franchising (fast food, business consulting services, cleaning services, others) Not the Least Interested

What Area Interests You Most

10. What would Help you Most in Starting Your own Business? Rank in order of Importance

	Critical Importance	Very Important	Somewhat Important	Not Important
Menu of Proven Opportunities with Track Records of Success	What would Help you Most in Starting Your own Business? Rank in order of Importance Menu of Proven Opportunities with Track Records of Success Critical Importance	Menu of Proven Opportunities with Track Records of Success Very Important	Menu of Proven Opportunities with Track Records of Success Somewhat Important	Menu of Proven Opportunities with Track Records of Success Not Important
Quickstart Guide Books to Begin Earning Money in 30 days	Quickstart Guide Books to Begin Earning Money in 30 days Critical Importance	Quickstart Guide Books to Begin Earning Money in 30 days Very Important	Quickstart Guide Books to Begin Earning Money in 30 days Somewhat Important	Quickstart Guide Books to Begin Earning Money in 30 days Not Important
Mentoring / Coaching to Guide & Check your progress	Mentoring / Coaching to Guide & Check your progress Critical Importance	Mentoring / Coaching to Guide & Check your progress Very Important	Mentoring / Coaching to Guide & Check your progress Somewhat Important	Mentoring / Coaching to Guide & Check your progress Not Important
Conference Calls with Experts in various fields of Self Employment	Conference Calls with Experts in various fields of Self Employment Critical Importance	Conference Calls with Experts in various fields of Self Employment Very Important	Conference Calls with Experts in various fields of Self Employment Somewhat Important	Conference Calls with Experts in various fields of Self Employment Not Important
Mindset, Motivation & Goal Setting to prepare for Self Employment	Mindset, Motivation & Goal Setting to prepare for Self Employment Critical Importance	Mindset, Motivation & Goal Setting to prepare for Self Employment Very Important	Mindset, Motivation & Goal Setting to prepare for Self Employment Somewhat Important	Mindset, Motivation & Goal Setting to prepare for Self Employment Not Important
Sources of Business Financing & Financial Counseling	Sources of Business Financing & Financial Counseling Critical Importance	Sources of Business Financing & Financial Counseling Very Important	Sources of Business Financing & Financial Counseling Somewhat Important	Sources of Business Financing & Financial Counseling Not Important

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Employment SurveyExit this survey