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* 1. Name

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* 2. Phone number

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* 3. Language

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* 4. Company

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* 5. Building

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* 6. Shift

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* 7. Starting pay: Right now, more new hires are paid $12.90 per hour and don't reach the regular wage ($15 or $15.25) until they have worked 2 years full time. What do you think? Pick one: 

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* 8. Seniority pay: Right now, janitors make the same if they have worked for the company for 2 – 14 years.  Janitors with 15 years make $0.25 more, and janitors with 20 years make $0.50 more.

What do you think?

Pick one:

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* 9. Shift differentials: Right now, you are paid the same no matter what shift you work. What do you think? Pick one: 

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* 10. A top goal of bargaining is to get raises for everyone. Aside from this, what is the ONE other pay issue most important to you? Pick one:

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* 11. Is there a type of work you think should get extra pay? Pick the one that is most important to you: Pick one

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* 12. Which ONE of these is the MOST important to you? Pick one:

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* 13. What is the ONE holiday you want MOST that we don't have now?

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* 14. Vacation: Have you had a problem getting vacation time approved when you wanted it? 

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* 15. Your insurance: Which of these situations applies to you?

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* 16. Do you have a spouse or domestic partner who you would want to put on the union insurance?

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* 17. Dental Insurance: Have you had problems with the costs for dental work under the union insurance? Pick one:

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* 18. Dental insurance: Pick one

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* 19. Vision insurance: Right now, if you have union health insurance you have a vision benefit that pays for your glasses and exams through VSP (not Kaiser). Pick one:

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* 20. The amount of work I am assigned is (pick one)

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* 21. Which ONE of these would be MOST helpful for you? Pick one:

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* 22. Other than higher pay, what is the one issue that is most important to you?

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* 23. Janitors in New York and California have union training programs that have created career opportunities and higher pay. We would like to create a program like that here in Oregon. Which on-the-job training would you be most interested in taking?

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* 24. Which of these training courses for skills outside of work would you be interested in taking?

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* 25. Please write any other improvements or changes you would like to see at work:

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* 26. Will you come to the Contract Kick-Off?

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* 27. Bargaining team: Who would be the best person to represent you and your coworkers when we bargain a new contract with your company? Please write their full name (first and last) here: 

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