Cole Resource Center Workforce Inquiry Survey
Thank you in advance for completing this survey. It has been designed so that CRC can best understand and meet the varied needs of our Workforce community. It should take no more than 5 minutes to complete and will allow us to meet with you to discuss our services. There are 4 sections of questions: Basic Info, Workforce Needs, Wellbeing, and Demographics (military service, cultural/ethnic background, and gender/sexuality). You may elect to skip any or all of the demographic section by selecting "Prefer not to say." Please note that we do not ask or require information about mental health conditions; by completing this survey, we assume that you meet the eligibility criteria of "living with a mental health challenge" and are seeking our specific services for that reason.
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Name
*
First Name
Last Name
Preferred Name (i.e., how you would like to be addressed by us if different from what you have listed above as "First Name")
Email
*
example@example.com
Zip Code
*
Current age (in years)
*
How did you hear about CRC's Workforce Program?
*
Internet Search, friend/family, clinical referral, etc.
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Employment Related Questions
What industry/ies have you previously worked in? Please type any that apply, or if you are new to job seeking, "none."
*
Examples of industry are Education, Healthcare, Tech, Arts, Nonprofit, Public Works, Retail, etc.
If different from the above, what industry are you seeking to work in?
Leave blank if you are not seeking work, or if the answer is the same as the previous response.
What will success look like to you after engaging with the program? Check all that apply.
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Completing a resume
Getting organized in my job search
Landing a job
Finding a volunteer opportunity
Finding community
Feeling less alone
Career Change Support
Prefer not to say
Other
Have you ever been employed?
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Yes
No
Prefer not to say
Are you currently employed?
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Yes
No
Prefer not to say
If you are currently in a career break, how long has it been since you were last employed?
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Current Support for Wellbeing
Who is providing the most support to you right now? Check all that apply.
*
Family
Friends
Therapeutic Team
Other
Prefer not to say
How supported do you feel by your family, friends and/or therapeutic team?
*
Very Supported
Somewhat supported
Not Supported At All
Prefer Not to Say
How supported do you feel in your job search/employment-related concerns from your family, friends and/or therapeutic team?
*
Very Supported
Somewhat Supported
Not Supported At All
Prefer Not to Say
How often do you feel lonely or disconnected from others?
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All of the time
Most of the time
Some of the time
Not at all
Prefer not to say
Other
How important is it to establish a meaningful connection with a coach during your time at CRC?
*
Very important
Somewhat important
Not important at all
Prefer not to say
How important is it to establish connections with peers during your time at CRC?
*
Very important
Somewhat important
Not important at all
Prefer not to say
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Demographic Information
Preferred Pronouns (leave blank if you prefer not to say)
What race or ethnicity best describes you? Check all that apply.
*
American Indian/Alaska Native
Asian/ Pacific Islander
Black or African American
Hispanic
White/ Caucasian
Multiple Ethnicities
Other
Prefer not to say
What primary languages do you speak at home? (leave blank if you prefer not to say)
Do you now or have you ever served in the U.S. military or otherwise qualify for Veteran/military status?
*
Yes
No
Prefer not to say
Voluntary self-identification of disability status:
*
Yes, I identify as having or have a history/record of having a disability.
No, I do not identify as having or have a history/record of having a disability.
I prefer not to answer.
What best describes your current gender identity?
*
Female
Male
Transgender
Non-binary
A gender not listed here
Prefer not tosay
Which of these best describes your current sexual orientation?
*
Asexual
Bisexual
Gay/Lesbian
Heterosexual/Straight
Pansexual
Queer
A sexual orientation not listed here
Prefer not to say
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Thank you for taking the CRC Workforce Program Intake Survey. Please click "submit" if you are finished. Select "Back" if you would like to review or change any answers.
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