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Unifor (Durham regional) Action (POWER) Centre
1.
First Name
2.
Last Name
3.
Telephone
4.
Personal Email Address
5.
Address
6.
Age
Under 30
30 - 39
40 - 49
50 +
7.
Gender Identity
8.
Please list any languages other than English in which you are fluent
9.
Your Workplace Position
Production Technician
Forklift driver
Picker/ Repack
Quality Control Tech
Body repair
Painter
EV Battery Technician
Shipping Receiving
Material Handler
Clerical
Skilled Trade
Team Leader
Janitor
Set Up
Maintenance
Other (please specify)
10.
How long were you employed with this employer?
Less than 5 years
5-10 years
10-15 years
15- 20 years
20-25 years
More than 25 years
11.
How urgent is it for you to find employment
Immediatly
Within 3 months
Within 6 months
No hurry
I Have a Part-time job
I have a Full-time job
I am in School
I retired
12.
Do you have plans for any of the following in the next 3 to 6 months?
Retraining
Looking for work
Retiring
Job already arranged
Retiring
Relocating
Other (please specify)
13.
Are you currently enrolled in any education or training program
Yes
No
14.
If you answered yes to the previous question, please specify what course and what institution.
15.
Do you have an updated resume prepared?
Yes
No
Other (please specify)
16.
If you answered yes to the previous question, how recently?
Last 3 months
6 months to a year
More than a year
17.
Are you interested in retraining or upgrading your skills?
Yes
No
18.
If yes, please indicate the education and training information you would be interested in having.
Educational upgrading and job re-training funding programs
Apprenticeships
Resources for improving basic reading, writing, and math skills
Getting a high school diploma or equivalency
Community college/university programs
Career College (trucking, heavy equipment, culinary etc.)
Skills Course: CNC machining, blueprint reading, etc.
Safe Food Handling Certificate
CPR/First Aid
Smart Serve
Upskilling (including obtaining work in the EV or Energy sector)
Other (please specify)
19.
What are some obstacles you identify that would make it difficult to participate in training/ returning to work?
Childcare
Transportation
Language Barrier
Skills gap
Health Concerns
Financial Constraints
Other (please specify)
20.
Any additional support needed
Mental Health support
Employment coaching
Financial assistance
Childcare
Transportation
Language training
Other (please specify)
21.
Do you have access to a computer and reliable internet service?
Yes
No
22.
Availability to attend training
Weekday daytime
Weekday Evenings
Weekends
Flexible
23.
Are you willing to commute or relocate to a new job?
Yes
No
24.
If yes, how far?
Within the Durham region
Within Ontario
Anywhere there is a good paying job
25.
What are your hourly wage requirements (complete one)?
$25 -$30
$30 - $35
$35 - $40
Over $40
26.
Do you plan to make use of the POWER centre?
Yes
No
27.
Your Education and Training
What is the highest level of education completed?
Less than Grade 12
High School Diploma (or GED)
Community or Career College
University Degree
28.
Please check the boxes to describe your English skills
Poor
I get by
Good
Very Good
Proficient
Speak
Read
Write
29.
How would you rate your math skills
1 star
2 stars
3 stars
4 stars
5 stars
30.
Can you use a scientific calculator?
Yes
No
31.
Please Check boxes to describe your computer skills
Excellent - I can handle any task
Ok - I get By
I need direction and guidance when doing a task
I do not even know what these are
I do not own a computer or tablet
Microsoft Word
Excellent - I can handle any task
Ok - I get By
I need direction and guidance when doing a task
I do not even know what these are
I do not own a computer or tablet
Emails
Excellent - I can handle any task
Ok - I get By
I need direction and guidance when doing a task
I do not even know what these are
I do not own a computer or tablet
Power Point (Slide Deck)
Excellent - I can handle any task
Ok - I get By
I need direction and guidance when doing a task
I do not even know what these are
I do not own a computer or tablet
Spread Sheets (Excel)
Excellent - I can handle any task
Ok - I get By
I need direction and guidance when doing a task
I do not even know what these are
I do not own a computer or tablet
Attaching documents to emails
Excellent - I can handle any task
Ok - I get By
I need direction and guidance when doing a task
I do not even know what these are
I do not own a computer or tablet
PowerPoint/Slide Deck
Excellent - I can handle any task
Ok - I get By
I need direction and guidance when doing a task
I do not even know what these are
I do not own a computer or tablet
On-line learning Platforms
Excellent - I can handle any task
Ok - I get By
I need direction and guidance when doing a task
I do not even know what these are
I do not own a computer or tablet
32.
How confident are you with Teams, Zoom or other online meeting platforms?
Extremely confident
Very confident
Somewhat confident
Not so confident
Not at all confident
33.
Please indicate any supports that would be of interest to you:
Resume preparation workshop
Job search workshop
Job interview workshop
Labour market information workshop
EI workshop
Career planning workshop
One-on-one career counseling
Educational upgrading and re-training opportunities and funding workshop
Budgeting and financial planning workshop
First Aid course
Social events and meetings to stay connected with co-workers
Social events and meetings to stay connected with co-workers
Computer Basic Skills Training
Public Speaking
Other (please specify)
34.
Are you on a work permit?
Yes
No
35.
Thank you for completing this questionnaire. We would value any additional comments or suggestions you may have.