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

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

* 3. How organized and productive do you feel ?

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

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

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

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

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

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

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

* 9. How is NIEFS doing?

  Poor Fair Average Good Excellent
Rank how effective the workshop was in meeting your needs?
Rank whether you would encourage others to take the workshop?
Rank what your overall experience of the workshop was?
Thank you for your time!
We appreciate you helping to make our services even better!

T