Single Parent Series

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* 1. Do you already have a daycare for your children?

Yes

My children are old enough to not need daycare

Other (please specify)

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* 2. Do you have a reliable way to get around? (to school, work, daycare, etc.)

Yes, I have a vehicle.

Yes, I use the bus.

Other. (please explain)

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* 3. How organized and productive do you feel ?

	Not at all		Moderately		Very
When working	When working Not at all	When working	When working Moderately	When working	When working Very
When in school	When in school Not at all	When in school	When in school Moderately	When in school	When in school Very
When at home	When at home Not at all	When at home	When at home Moderately	When at home	When at home Very

Other (please specify)

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* 4. Do you have family and/or friends in your life who support you in a positive way?

Yes

Other (please specify)

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* 5. Are you able to afford your basic living costs at the moment? (food, shelter, bills)

Yes

For the most part

I just barely get by

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* 6. What worries you most about going back to school and/or work? (choose as many as you like)

staying organized

ability to learn new things

not enough money

my children's reaction to the upcoming change

my ability to handle this change

managing time

not enough time for family and/or fun

not being able to get good grades in school

what if I don't like the type of work I choose (make the wrong life choice)

Other (please specify)

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* 7. Employ-ability Skills Checklist - the following will help you evaluation your confidence with the skills below.

	Not at all Confident		Neutral		Very Confident
Get tasks done on time?	Get tasks done on time? Not at all Confident	Get tasks done on time?	Get tasks done on time? Neutral	Get tasks done on time?	Get tasks done on time? Very Confident
When one work task is completed, look for another appropriate task on your own?	When one work task is completed, look for another appropriate task on your own? Not at all Confident	When one work task is completed, look for another appropriate task on your own?	When one work task is completed, look for another appropriate task on your own? Neutral	When one work task is completed, look for another appropriate task on your own?	When one work task is completed, look for another appropriate task on your own? Very Confident
Apply yourself to an uninteresting job without being easily distracted?	Apply yourself to an uninteresting job without being easily distracted? Not at all Confident	Apply yourself to an uninteresting job without being easily distracted?	Apply yourself to an uninteresting job without being easily distracted? Neutral	Apply yourself to an uninteresting job without being easily distracted?	Apply yourself to an uninteresting job without being easily distracted? Very Confident
Follow instructions or ask questions when instructions are unclear?	Follow instructions or ask questions when instructions are unclear? Not at all Confident	Follow instructions or ask questions when instructions are unclear?	Follow instructions or ask questions when instructions are unclear? Neutral	Follow instructions or ask questions when instructions are unclear?	Follow instructions or ask questions when instructions are unclear? Very Confident
Accept criticism without feeling hurt?	Accept criticism without feeling hurt? Not at all Confident	Accept criticism without feeling hurt?	Accept criticism without feeling hurt? Neutral	Accept criticism without feeling hurt?	Accept criticism without feeling hurt? Very Confident
Work successfully without constant supervision?	Work successfully without constant supervision? Not at all Confident	Work successfully without constant supervision?	Work successfully without constant supervision? Neutral	Work successfully without constant supervision?	Work successfully without constant supervision? Very Confident
Have a positive attitude at work?	Have a positive attitude at work? Not at all Confident	Have a positive attitude at work?	Have a positive attitude at work? Neutral	Have a positive attitude at work?	Have a positive attitude at work? Very Confident
Learn new skills and tasks?	Learn new skills and tasks? Not at all Confident	Learn new skills and tasks?	Learn new skills and tasks? Neutral	Learn new skills and tasks?	Learn new skills and tasks? Very Confident
Learn more about the 'real' work environment that you are interested in?	Learn more about the 'real' work environment that you are interested in? Not at all Confident	Learn more about the 'real' work environment that you are interested in?	Learn more about the 'real' work environment that you are interested in? Neutral	Learn more about the 'real' work environment that you are interested in?	Learn more about the 'real' work environment that you are interested in? Very Confident
Ask questions?	Ask questions? Not at all Confident	Ask questions?	Ask questions? Neutral	Ask questions?	Ask questions? Very Confident
Learn new skills and new ways of doing things?	Learn new skills and new ways of doing things? Not at all Confident	Learn new skills and new ways of doing things?	Learn new skills and new ways of doing things? Neutral	Learn new skills and new ways of doing things?	Learn new skills and new ways of doing things? Very Confident
Show up for every shift you are scheduled for?	Show up for every shift you are scheduled for? Not at all Confident	Show up for every shift you are scheduled for?	Show up for every shift you are scheduled for? Neutral	Show up for every shift you are scheduled for?	Show up for every shift you are scheduled for? Very Confident
Show up for work on time?	Show up for work on time? Not at all Confident	Show up for work on time?	Show up for work on time? Neutral	Show up for work on time?	Show up for work on time? Very Confident
Don't take longer breaks than you are entitled to?	Don't take longer breaks than you are entitled to? Not at all Confident	Don't take longer breaks than you are entitled to?	Don't take longer breaks than you are entitled to? Neutral	Don't take longer breaks than you are entitled to?	Don't take longer breaks than you are entitled to? Very Confident
Finish tasks you are given?	Finish tasks you are given? Not at all Confident	Finish tasks you are given?	Finish tasks you are given? Neutral	Finish tasks you are given?	Finish tasks you are given? Very Confident

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* 8. AT WORK, how confident are you in the following abilities:

	Not at all Confident		Neutral		Very Confident
Offer help if others need it?	Offer help if others need it? Not at all Confident	Offer help if others need it?	Offer help if others need it? Neutral	Offer help if others need it?	Offer help if others need it? Very Confident
Have a sense of responsibility?	Have a sense of responsibility? Not at all Confident	Have a sense of responsibility?	Have a sense of responsibility? Neutral	Have a sense of responsibility?	Have a sense of responsibility? Very Confident
Look for ways to be part of the team?	Look for ways to be part of the team? Not at all Confident	Look for ways to be part of the team?	Look for ways to be part of the team? Neutral	Look for ways to be part of the team?	Look for ways to be part of the team? Very Confident
Make an effort to meet new people?	Make an effort to meet new people? Not at all Confident	Make an effort to meet new people?	Make an effort to meet new people? Neutral	Make an effort to meet new people?	Make an effort to meet new people? Very Confident
Enjoy talking with co-workers during breaks or at lunch?	Enjoy talking with co-workers during breaks or at lunch? Not at all Confident	Enjoy talking with co-workers during breaks or at lunch?	Enjoy talking with co-workers during breaks or at lunch? Neutral	Enjoy talking with co-workers during breaks or at lunch?	Enjoy talking with co-workers during breaks or at lunch? Very Confident
Provide polite and respectful service to your customers?	Provide polite and respectful service to your customers? Not at all Confident	Provide polite and respectful service to your customers?	Provide polite and respectful service to your customers? Neutral	Provide polite and respectful service to your customers?	Provide polite and respectful service to your customers? Very Confident
Know how to work in a team to get the job done?	Know how to work in a team to get the job done? Not at all Confident	Know how to work in a team to get the job done?	Know how to work in a team to get the job done? Neutral	Know how to work in a team to get the job done?	Know how to work in a team to get the job done? Very Confident
Treat your co-workers with respect?	Treat your co-workers with respect? Not at all Confident	Treat your co-workers with respect?	Treat your co-workers with respect? Neutral	Treat your co-workers with respect?	Treat your co-workers with respect? Very Confident
Co-operate with supervisors and managers?	Co-operate with supervisors and managers? Not at all Confident	Co-operate with supervisors and managers?	Co-operate with supervisors and managers? Neutral	Co-operate with supervisors and managers?	Co-operate with supervisors and managers? Very Confident
Dress appropriately for work?	Dress appropriately for work? Not at all Confident	Dress appropriately for work?	Dress appropriately for work? Neutral	Dress appropriately for work?	Dress appropriately for work? Very Confident
Inform yourself about company policies?	Inform yourself about company policies? Not at all Confident	Inform yourself about company policies?	Inform yourself about company policies? Neutral	Inform yourself about company policies?	Inform yourself about company policies? Very Confident
Speak positively about your employer, co-workers and customers?	Speak positively about your employer, co-workers and customers? Not at all Confident	Speak positively about your employer, co-workers and customers?	Speak positively about your employer, co-workers and customers? Neutral	Speak positively about your employer, co-workers and customers?	Speak positively about your employer, co-workers and customers? Very Confident
Confident in your ability to be in a position of trust and responsibility?	Confident in your ability to be in a position of trust and responsibility? Not at all Confident	Confident in your ability to be in a position of trust and responsibility?	Confident in your ability to be in a position of trust and responsibility? Neutral	Confident in your ability to be in a position of trust and responsibility?	Confident in your ability to be in a position of trust and responsibility? Very Confident
Clean and well groomed when you arrive for work?	Clean and well groomed when you arrive for work? Not at all Confident	Clean and well groomed when you arrive for work?	Clean and well groomed when you arrive for work? Neutral	Clean and well groomed when you arrive for work?	Clean and well groomed when you arrive for work? Very Confident
Adapt to new and unexpected situations easily?	Adapt to new and unexpected situations easily? Not at all Confident	Adapt to new and unexpected situations easily?	Adapt to new and unexpected situations easily? Neutral	Adapt to new and unexpected situations easily?	Adapt to new and unexpected situations easily? Very Confident
Acknowledge your strengths and weaknesses?	Acknowledge your strengths and weaknesses? Not at all Confident	Acknowledge your strengths and weaknesses?	Acknowledge your strengths and weaknesses? Neutral	Acknowledge your strengths and weaknesses?	Acknowledge your strengths and weaknesses? Very Confident

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* 9. How is NIEFS doing?

	Poor	Fair	Average	Good	Excellent
Rank how effective the workshop was in meeting your needs?	Rank how effective the workshop was in meeting your needs? Poor	Rank how effective the workshop was in meeting your needs? Fair	Rank how effective the workshop was in meeting your needs? Average	Rank how effective the workshop was in meeting your needs? Good	Rank how effective the workshop was in meeting your needs? Excellent
Rank whether you would encourage others to take the workshop?	Rank whether you would encourage others to take the workshop? Poor	Rank whether you would encourage others to take the workshop? Fair	Rank whether you would encourage others to take the workshop? Average	Rank whether you would encourage others to take the workshop? Good	Rank whether you would encourage others to take the workshop? Excellent
Rank what your overall experience of the workshop was?	Rank what your overall experience of the workshop was? Poor	Rank what your overall experience of the workshop was? Fair	Rank what your overall experience of the workshop was? Average	Rank what your overall experience of the workshop was? Good	Rank what your overall experience of the workshop was? Excellent

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