Please read the following statements and check the most appropriate response based upon the past 6 months of individual's employment

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* 1. Business Name:

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* 2. Employee Name:

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* 3. Date Employed:

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* 4. Person Completing Survey:

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* 5. Date Survey Completed:

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* 6. Before the employee started, Goodwill provided adequate information and answered questions about their services.

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* 7. Goodwill's staff provided assistance and training to other employees regarding working with the new employee if it was needed.

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* 8. If a job coach was used, did he/she offer training and support to the employee so that he/she can complete the job and related duties to my standards.

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* 9. Goodwill staff has been responsive to our questions and/or concerns.

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* 10. The services provided by Goodwill have been prompt.

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* 11. Goodwill staff has been courteous and professional.

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* 12. There is open communication between our business and Goodwill.

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* 13. I would contact Goodwill if another position opened up in our agency.

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* 14. Our business is satisfied with the ongoing support services provided by Goodwill.

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* 15. Goodwill assisted in making necessary modifications or accommodations to enable the employee to maintain an optimum level of independent employment.

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* 16. I would be interested in being a referral to possible employers of individuals who have disabilities.

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* 17. Are there any other needs that Goodwill can assist you in addressing with the employee?

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* 18. Use the following rating scale of 1 to 5 (5 being the highest rating) to evaluate the employee according to competitive employment standards.

Co-worker relations

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* 19. Cooperation with Supervisor

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* 20. Punctuality/Attendance

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* 21. Remembers job details

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* 22. Motivation

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* 23. Stamina

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* 24. Quality of work

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* 25. Attitude

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* 26. Follows safety rules

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* 27. Additional Comments:

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* 28. How likely are you to recommend Goodwill to other colleagues/friends?

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Please rate on a scale of 1 to 10, with 10 being the most likely to refer others.

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