Westcoast Older Worker Initiative (WOWI) Survey

SECTION A - CONTACT INFORMATION & PROFILE

First Name

Last Name

Mailing Address (PO Box)

The place where I receive my mail is

Postal Code

Phone Number

Email

The place where I live is called

I am

My age group is

The annual income of my household is

I am

SECTION B - EMPLOYMENT SITUATION

I am currently

I am currently working as a

I would like to work

My challenge in obtaining/maintaining employment is (check all that apply)

To get to work, I need to take a (check all that apply)

I would like to continue to work if I could work

I would like to work if my hours were

SECTION C - EMPLOYABILITY SKILLS - SELF ASSESSMENT

I have experience in (check all that apply)

I have experience working in (check all that apply)

I have received certification in (check all that apply)

I have operated equipment such as (check all that apply)

I have experience in working with (check all that apply)

I have the following job-related skills (check all that apply)

I consider myself as someone who who is (check all that apply)

I consider myself as someone who learns best by

I have difficulty with (check all that apply)

I consider my greatest strength(s) to be (check all that apply)

I would like to learn new skills

I am interested in having help with learning how to (check all that apply)

SECTION D - RETIREMENT

I see myself as being unable to retire because I (check all that apply)

I would like to become fully retired when I am

SECTION E - PRIZE DRAW

Please enter my name for a chance to win a prize

Please contact me


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