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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.
1.Personal Information
2.Age:
3.Please list any language other than English that you understand and check the boxes to indicate your skills in the language:
Work Profile
4.Your last job (please check all that apply):
5.How long were you employed with your last employer?
Action Centre Feedback
6.Do you have plans for the next 3-6 months following the layoff?
7.If so, what are your plans?
8.Are you interested in retraining or upgrading your skills?
9.Are you considering self-employment?
10.Are you willing to commute or relocate to a new job?
11.What are your hourly wage requirements? (select one)
Your Education and Training
12.What is the highest level of education completed?
13.Are you currently enrolled in any education or training program?
14.Please check the boxes to describe your English skills:
Speak
Read
Write
15.Please check the box to describe your Math skills:
16.Please check boxes below to describe your present computer skills in each area:
Using email, internet
Word processing (Microsoft Word)
Spreadsheet (Excel, 1-2-3, etc.)
17.Please indicate the education and training information you would be interested in having:
18.Please indicate any supports that would be of interest to you:
19.Thank you for completing this questionnaire.  We would value any additional comments or suggestions you may have.