* 1. Click the job titles that most closely approximates your job duties most of the time (you can click more than one)

* 2. Which of the following describes your racial/ethnic identity (click all that apply)?

* 3. At my agency of employment, the racial/ethnic diversity of the clients we serve is reflected in our diverse workforce. 

* 4. At my agency/organization of employment, there is a safe procedure for reporting and addressing racial/ethnic discrimination, I see or experience in the workplace.

* 5. What languages do you speak (Click all that apply)?

* 6. Please identify your gender:

* 7. What is your sexual orientation (select all that apply)?

* 8. At my agency/organization of employment, there is a safe procedure for reporting and addressing sexual harassment and sexual discrimination, I see or experience in the workplace.

* 9. What is your age?

* 11. Are you currently serving in the United States military?

* 12. Are you a Veteran of the United States Armed Forces?

* 13. Do you identify as a person in recovery, having lived-experience with a mental health or substance use/gambling disorder?

* 14. My agency/organization fully supports employees who are in recovery from a mental health, substance use, and/or gambling disorder.

* 15. For those in recovery: I take a reasonable amount of time each week to focus on sustaining my own recovery.

* 16. For those in recovery: Are you now or have you been previously employed by an agency where you were once a client?

* 17. Do you have a disabling mental or emotional condition?

* 18. Do you have a disabling physical condition?

* 19. For those with a disability, does your employer provide reasonable accommodations?

* 20. For those with a disability, can you reasonably take time off as needed without worrying about staff coverage in your absence?

* 21. Credentials (click all credentials that you currently possess):

* 22. What is your level of education?

* 23. Specialized Occupational Training: please estimate the number of specialty mental health/addiction training hours you have accumulated outside of college (specialized training, workshops, seminars, conferences, training programs, etc.)

* 24. Are you currently enrolled in a degree program?

* 25. Do you owe money on student loans?

* 26. If so, approximately how much do you owe in student loans?

* 27. Are you or have you participated in Student Loan Forgiveness? If so, through which?

* 28. Answer at least one of these questions, and preferably all three, to the best of your ability:

* 29. On average, how many hours do you work per week?

* 30. At my agency/organization, we typically receive annual Cost of Living Allowances, pay raises/(COLA):

* 31. Health, Life & Disability Insurance (click all that apply):

* 32. Does your employer provide any of the following? (click all that apply):

* 33. Which of the following benefits do you receive? (click all that apply):

* 34. When taking personal time/vacation time, can you reasonably take time off without worrying about staff coverage in your absence?

* 35. How does your agency award merit/step pay increases? What are they based upon? (not cost of living increases)

* 36. How satisfied are you with your current income?

* 37. How satisfied are you with your current benefit package?

* 38. Does your agency have sufficient/appropriate staff coverage for the number of clients being served?

* 39. What is your average client caseload?

* 40. What should your caseload be?

* 41. How many hours of direct face-to-face service do you provide per week on average?

* 42. Do you regularly work evenings?

* 43. Do you regularly work weekends?

* 44. Does your agency offer flex-time?

* 45. At how many different locations do you work?

* 46. Do you currently work for more than one agency?

* 47. Do you have a criminal history? (any arrests and/or any convictions for misdemeanors, felonies)

* 48. Have you ever had a child welfare case, or a DHS case for alleged abuse of a vulnerable population?

* 49. For those with a criminal record: Have you had your criminal record expunged?

* 50. For those with a criminal record: Have you ever been denied employment in the behavioral health field as a result of a background check?

* 51. For those with a criminal record: Has your employment in the behavioral health field ever been “held up” as a result of a pending background check?

* 52. For those with a criminal record: Has an offer of employment ever been withdrawn as a result of waiting an extended period of time for the results of a background check?

* 53. What are your plans in the future?

* 54. How many cumulative years/months have you worked in behavioral health?

* 55. How many different agencies have you worked for in the behavioral health field?

* 56. How often do you look at help wanted/job postings?

* 57. How satisfied are you in your current position?

* 58. Where do you work most of the time?

* 59. How would you rate the aesthetics (appearance) of your work environment?

* 60. How would you rate the spaciousness of your work environment (for confidential office space, individual and group meeting spaces)?

* 61. How would you rate the physical safety of your work environment (including unsafe structures, potential physical violence, etc.)?

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