1.

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* 1. What was your initial reason for coming to Multi-Service Center?

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* 2. How did you hear about the employment program? (Please check one)

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* 3. Please list specific referral source if you chose Personal Referral, Case Manager Referral or Other in Question 2.

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* 4. Did MSC help you achieve your employment goal(s)?

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* 5. If you answered No to Question 4, please explain:

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* 6. Please check any of the following employment search skills you feel you improved as a result of meeting with your Employment Specialist:

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* 7. If you selected Other in Question 6, please list here.

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* 8. What was the most helpful to you?

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* 9. On a scale of 1-5, please rate your job search skills before and after meeting with your Employment Specialist (5 = I can reach my job search goals and 1 = I have very little chance of finding a job)

  1 2 3 4 5
Job search skills before
Current job search skills

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* 10. Was your experience with the MSC employment program satisfactory?

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* 11. If you answered No to Question 10, please explain:

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* 12. Will you recommend our services to a friend?

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* 13. If you answered No to Question 12, please explain:

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* 14. What other employment related services would you like to see offered by MSC?

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* 15. Additional Comments

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* 16. Contact information (optional)

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