Completion of Needs Survey by Affected Workers

The manager may consider enclosing a "Needs Survey" in the separation packet that is given to the affected worker at the time of the layoff.  The Needs Survey should be completed by the affected worker and provided to the staff at WORKFORCE CENTRAL FLORIDA.
 
By completing the Needs Survey, the affected worker can focus on his/her immediate future needs and begin the process of finding new employment.  It will help the worker identify current skills, knowledge and abilities, and also identify how he/she may possibly benefit from additional training or certification.  The information contained on the Needs Survey will help WORKFORCE CENTRAL FLORIDA staff to identify the specific needs of the worker and provide those services as quickly as possible.  A sample "Needs Survey" is below.
 
SAMPLE: Needs Survey
Please answer all questions in this questionnaire.  The information you give will help us provide a program to meet your personal training and career needs and concerns associated with this layoff. You are not required to provide personal information, but the completion of this survey would be greatly appreciated.  Individual answers will be CONFIDENTIAL.
 
Name _____________________________________________
(first, last)
Address _____________________________________________
(street)___________________________________________
(city, county, state, zip)
Phone __________________   Age ______
Male_____    Female _____
Marital Status:   Married _____    Single ______    Single Parent______
Number of Dependents:   ______ Under 18   ______ Over 18
Veteran:   _____ Yes   ______ No
 
Job Search Assistance
Check all areas of interest/need:
 
Resume Writing
 
Applications
 
Interviewing Techniques
 
Cover Letters
 
Job Leads/Contacts
 
Career Planning
 
Employment Agencies
 
Career Testing
 
Telephone Techniques
 
Self Employment
 
Video Taping
 
Other
 
Long Distance Job Leads/Information
 
 

 
Education and Training
Check all areas of interest/need. Financial assistance may be available for the following areas:
 
GED Testing
 
English as a Second Language
 
Community Colleges
 
On-the-Job Training
 
Vocational Schools
 
Basic Education Classes
 
Computer Skills
 
Other

 
Area of Career Interest (Please explain in detail):
Education
Please check the highest level attained:
 
8th Grade or Less
 
Professional Certificate and Licenses>
 
9th - 12th Grade
 
High School Diploma
 
1 - 2 Years College
 
College Degree(s)
 
Vocational - Technical School
 
 

 
Years of Employment with ________ - ________ Years
Future Plans
Check any that may apply. Do you plan to or have you begun to:
 
Search for another job
 
Retire
 
Enter a retraining program
 
Search for work upon or after layoff
 
Enroll in school
 
Open your own business
 
Need assistance with making a decision

 
Concerns
Please check all that may apply:
 
Lack of skills
 
Education
 
Limited English skills
 
Disability
 
Child care availability
 
Age discrimination
 
Transportation
 
Sex discrimination
 
Relocation possibilities
 
Other (specify)

 
Moving and Relocation
Please check all that may apply:
_____Willing to relocate to a different area
Number of miles you are willing to commute to a new job:
___1-10    ___11-20    ___21-30    ___31-40    ___40+
 
 
Personal Assistance and Information
If you feel that any of the following issues are of concern, please check all that may apply:
 
Financial management (budget preparation)
 
Medical/health insurance
 
Credit/debt management
 
Unemployment benefits
 
Stress management
 
Selling a home
 
Educational financial aid
 
Moving costs of relocation
 
Family issues/counseling
 
Veterans benefits
 
Alcohol/drug use<
 
Mortgage/rent payments
 
Food stamps/AFDC
 
Disability payments
 
Legal issues
 
Retirement planning
 
Social Security benefits
 
 

 
Other Concerns (please specify):
Salary
What is the minimum salary/wage you would accept in your next job?
___$7 - 10    ___$11-13    ___$13-15    ___More than $15 
Please express any other concerns or comments that you feel might assist in the planning of programs and resources for you and other effected employees.