Dislocated Worker Transitional Reemployment Services Survey

Instructions: All information in this survey is confidential and will be used for planning purposes only. Many of the questions asked are about the kinds of services that may be helpful to you. We will use the responses to help create a plan as you transition from employment at WestRock. Those fields indicated with an asterisk (*) are required. Please answer all questions to the best of your ability. Thank you for taking part in this survey.

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1. Name and contact information (Required.)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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2. Last four of SSN (Required.)

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3. Date of birth (Required.)

Date

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4. Are you a veteran?

Yes

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5. Job Title of current job or job or recent layoff (Required.)

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6. Number of years with company (Required.)

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7. Most Recent Wage/Salary (complete one) (Required.)

Hourly wage/salary amount OR

Weekly wage/salary amount OR

Monthly wage/salary amount OR

Annual wage/salary amount

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8. Anticipated layoff date or last day worked

Date

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9. Describe your main job duties

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10. List machinery, tools, computer software, etc. that you can use

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11. Highest school grade completed (K-12 or GED) (Required.)

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12. List any additional formal training or education: (Required.)

Vocational/Technical/Trade School

Some college but no degree

Associate degree/Professional Certificate

Bachelor degree

Graduate degree (MA, MS MBA, PhD, etc.)

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13. Current Certifications/Licensures held

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14. Expiration date of certifications/licensures

Date

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15. Are you a union member? (This information may be needed for unemployment compensation)

Yes

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16. If yes, Union name:

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17. Union number

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18. Which of the following options are you considering most seriously now? (Mark all that apply)

Seek employment in my field (not necessarily my same job title)

Seek employment in a new field

Start my own business

Attend school or training program

Work part time

Retirement

Undecided

Other (please specify)

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19. Are you currently enrolled in a school or training institution?

Yes

If yes, where and the type of training that you are receiving

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20. Which of the following assistance/services would be most helpful in getting the job you want? (Mark all that apply)

Choosing a new career

Career (vocational) counseling

Vocational classroom training/training in a new job skill

Work-based training (On-the-job training)

Starting my own business

Job placement assistance

Writing resume/employment letters

Interviewing skills/filling out applications

Testing to determine job interests and skills

Updating basic skills (Math, English, Reading and/or Writing)

GED preparation

Updating existing skills

Computer skills

Money management/financial counseling

Family/personal counseling

Childcare/dependent care (while looking for work or in school)

Help with transportation (while looking for work or in school)

Coping with change

Information on health insurance coverage

Information regarding veteran’s benefits

Housing assistance

Other (please specify)

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21. Would you be interested in attending workshops to learn the latest job seeking methods?

Yes

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22. Are you willing to relocate for a new job?

Yes

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23. How many miles are you willing to drive for a new job?

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24. What is the hourly pay rate you are willing to accept?

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25. What kind of work would you really like to do?

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26. Do you have a valid driver’s license?

Yes

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27. Have you received public assistance in the last 5 years?

Yes

Dislocated Worker Transitional Reemployment Services Survey

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* 1. Name and contact information (Required.)

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* 2. Last four of SSN (Required.)

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* 3. Date of birth (Required.)

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* 4. Are you a veteran?

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* 5. Job Title of current job or job or recent layoff (Required.)

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* 6. Number of years with company (Required.)

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* 7. Most Recent Wage/Salary (complete one) (Required.)

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* 8. Anticipated layoff date or last day worked

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* 9. Describe your main job duties

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* 10. List machinery, tools, computer software, etc. that you can use

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* 11. Highest school grade completed (K-12 or GED) (Required.)

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* 12. List any additional formal training or education: (Required.)

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* 13. Current Certifications/Licensures held

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* 14. Expiration date of certifications/licensures

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* 15. Are you a union member? (This information may be needed for unemployment compensation)

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* 16. If yes, Union name:

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* 17. Union number

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* 18. Which of the following options are you considering most seriously now? (Mark all that apply)

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* 19. Are you currently enrolled in a school or training institution?

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* 20. Which of the following assistance/services would be most helpful in getting the job you want? (Mark all that apply)

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* 21. Would you be interested in attending workshops to learn the latest job seeking methods?

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* 22. Are you willing to relocate for a new job?

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* 23. How many miles are you willing to drive for a new job?

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* 24. What is the hourly pay rate you are willing to accept?

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* 25. What kind of work would you really like to do?

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* 26. Do you have a valid driver’s license?

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* 27. Have you received public assistance in the last 5 years?

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* 28. Please tell us anything else about your plans, needs, or training that you feel would be helpful for us to know.

1. Name and contact information (Required.)

2. Last four of SSN (Required.)

3. Date of birth (Required.)

4. Are you a veteran?

5. Job Title of current job or job or recent layoff (Required.)

6. Number of years with company (Required.)

7. Most Recent Wage/Salary (complete one) (Required.)

8. Anticipated layoff date or last day worked

9. Describe your main job duties

10. List machinery, tools, computer software, etc. that you can use

11. Highest school grade completed (K-12 or GED) (Required.)

12. List any additional formal training or education: (Required.)

13. Current Certifications/Licensures held

14. Expiration date of certifications/licensures

15. Are you a union member? (This information may be needed for unemployment compensation)

16. If yes, Union name:

17. Union number

18. Which of the following options are you considering most seriously now? (Mark all that apply)

19. Are you currently enrolled in a school or training institution?

20. Which of the following assistance/services would be most helpful in getting the job you want? (Mark all that apply)

21. Would you be interested in attending workshops to learn the latest job seeking methods?

22. Are you willing to relocate for a new job?

23. How many miles are you willing to drive for a new job?

24. What is the hourly pay rate you are willing to accept?

25. What kind of work would you really like to do?

26. Do you have a valid driver’s license?

27. Have you received public assistance in the last 5 years?

28. Please tell us anything else about your plans, needs, or training that you feel would be helpful for us to know.