Measure Name: | MOCK Completer v3 | |||||
MID: | U0shQ49o8tlopdN9Nc0RZA== | |||||
Completer-Model questions utilize the ACSI methodology to determine scores and impacts | ||||||
ELEMENTS (drivers of satisfaction) | CUSTOMER SATISFACTION | FUTURE BEHAVIORS | ||||
Job Announcement (1=Poor, 10=Excellent, Don't Know) | Satisfaction (1=Poor, 10=Excellent) | Likelihood to Return (=Not Very Likely, 10=Very Likely) | ||||
1 | Please rate how well the job announcements helped you understand the job duties. | 10 | What is your overall satisfaction with this job application process? | 13 | How likely are you to <b>return to apply for a specific job at this agency in the future</b>? | |
2 | Please rate how well the job announcements helped you understand the qualifications required for the position. | 11 | How well does this job application process meet your expectations? | Likelihood to Recommend (1=Not Very Likely, 10=Very Likely) | ||
3 | Please rate how well the job announcements provided answers to your questions. | 12 | How does this job application process compare to your idea of an ideal job application process? | 14 | How likely are you to <b>recommend someone else apply for a job with this agency</b>? | |
4 | Please rate your overall satisfaction with the job announcement. | |||||
Job Application Process (1=Poor, 10=Excellent, Don't Know) | ||||||
Please rate the length of time it took to complete this application. | ||||||
Please rate the amount of documentation required to complete this application. | ||||||
Please rate the instructions for applying for this job. | ||||||
Please rate the process of applying for this job. |
Measure Name: | MOCK Completer v3 | ||||||||
MID: | U0shQ49o8tlopdN9Nc0RZA== | ||||||||
Completer Survey, cont. | |||||||||
Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | ||
EDO02546 | How long did it take you to finish your application? | Less than one hour | Radio button, one-up vertical | ||||||
1-2 hours | |||||||||
3-4 hours | |||||||||
More than four hours | |||||||||
EDO02547 | What documents were you required to submit for this position? | Resume only, no other documents | Radio button, one-up vertical | Single | Y | ||||
A resume and an assessment questionnaire | |||||||||
Other, please specify | A | ||||||||
EDO02548 | A | Other_documents submitted | Text area, no char limit | N | |||||
AED12560 | How do you feel the Federal job application process compares to private sector job application processes? | Federal job application process is more cumbersome. | Radio button, two-up vertical | Single | Y | ||||
Federal job application process is less cumbersome. | |||||||||
Federal job application process and private sector job application process are about the same. | |||||||||
EDO02549 | What is your number one reason for applying for this position with the Federal government? (Choose only one answer) | Salary | Radio button, one-up vertical | Single | Y | ||||
Career advancement opportunities | |||||||||
Interested in the location of the job | |||||||||
A chance for public service (want to work for the Federal gov't) | |||||||||
Interested in duties of the position | |||||||||
Interested in working for this agency | |||||||||
Flexible schedules, such as tele-work | |||||||||
Other, please specify | A | ||||||||
EDO02550 | A | Please tell us any other reasons you are interested in applying for this position. | Text area, no char limit | N | |||||
ACQOsl0002055 | Do you know how to check the current status of your application? | Yes | Drop down, select one | Single | Y | ||||
No | |||||||||
EDO02551 | Are you currently employed? | Yes | Drop down, select one | Single | Y | ||||
No | |||||||||
EDO02553 | Have you ever worked for the Federal Government? | Yes, I currently work for the Federal government | B | Drop down, select one | Single | Y | Skip Logic | ||
Yes, I have worked for the Federal government but currently do not | |||||||||
No, I have never worked for the Federal government | |||||||||
EDO02556 | B | If yes, what is the highest grade level position you have held with the Federal Government? | GS-1 or equivalent | Drop down, select one | Single | N | Skip Logic | ||
GS-2 or equivalent | |||||||||
GS-3 or equivalent | |||||||||
GS-4 or equivalent | |||||||||
GS-5 or equivalent | |||||||||
GS-6 or equivalent | |||||||||
GS-7 or equivalent | |||||||||
GS-8 or equivalent | |||||||||
GS-9 or equivalent | |||||||||
GS-10 or equivalent | |||||||||
GS-11 or equivalent | |||||||||
GS-12 or equivalent | |||||||||
GS-13 or equivalent | |||||||||
GS-14 or equivalent | |||||||||
GS-15 or equivalent | |||||||||
SES/SL/ST | |||||||||
Don't know | |||||||||
Other, please specify | A | ||||||||
AED12561 | A | Other_highest grade level held | Text area, no char limit | N | |||||
EDO02557 | How did you hear about this job? | I was notified via a USAJOBS automated search agent | Radio button, one-up vertical | Multi | Y | OPS Group | |||
I routinely search USAJOBS | |||||||||
College career service center | |||||||||
Social media (Facebook, Twitter, etc.) | |||||||||
I attended a recruitment event where I met with agency representatives | |||||||||
Visited the agency website | |||||||||
I was referred to the position by an employee of that agency | |||||||||
Agency print ad | |||||||||
Referred by an associate/friend | |||||||||
Found it on another job board or search agent other than USAJOBS | |||||||||
Other, please specify | A | ||||||||
EDO02558 | A | Other_hear about job | Other_hear about job | Text area, no char limit | OpS Group | ||||
EDO02560 | Have you graduated college or obtained your degree within the last two years? | Yes | Drop down, select one | Single | Y | ||||
No | |||||||||
EDO02561 | What is the highest level of education you have attained? | High school diploma | Radio button, one-up vertical | Single | Y | OPS Group | |||
Some college | |||||||||
Technical or vocational degree | |||||||||
Associate Degree | |||||||||
Bachelor's degree | |||||||||
Master's degree | |||||||||
Advanced degree (Ph.D, JD, etc) | |||||||||
Other, please specify | A | ||||||||
EDO02562 | A | Other_level of education | Text area, no char limit | N | OpS Group | ||||
EDO02563 | How many years of experience do you have in your current career field? | 0-2 Years | Radio button, one-up vertical | Y | |||||
3-5 Years | |||||||||
6-10 Years | |||||||||
11-15 Year | |||||||||
More than 15 years | |||||||||
EDO02564 | What Federal grade level position are you applying for today? | GS-1 or equivalent | Drop down, select one | Single | Y | ||||
GS-2 or equivalent | |||||||||
GS-3 or equivalent | |||||||||
GS-4 or equivalent | |||||||||
GS-5 or equivalent | |||||||||
GS-6 or equivalent | |||||||||
GS-7 or equivalent | |||||||||
GS-8 or equivalent | |||||||||
GS-9 or equivalent | |||||||||
GS-10 or equivalent | |||||||||
GS-11 or equivalent | |||||||||
GS-12 or equivalent | |||||||||
GS-13 or equivalent | |||||||||
GS-14 or equivalent | |||||||||
GS-15 or equivalent | |||||||||
SES/SL/ST | |||||||||
Not sure | |||||||||
Other, please specify | |||||||||
AED12739 | A | Other_Federal grade level applying for | Text area, no char limit | N | |||||
EDO02552 | Are you a Veteran | Yes | Drop down, select one | Single | Y | ||||
No | |||||||||
AED12562 | If you could make ONE improvement to this job application process, what would it be? | Better information on what to expect next | Radio button, one-up vertical | Single | Y | OpS Group | |||
Information on when I should expect to hear if I am being considered for the position | |||||||||
Easier to understand job opportunity announcements | |||||||||
Integrate all hiring systems so applicants only have to enter their resume/information one time | |||||||||
No written essays | |||||||||
Better information on how I will be evaluated | |||||||||
Other, please specify | A | ||||||||
EDO02565 | A | Other_improvement | Text area, no char limit | N | OpS Group | ||||
EDO02566 | We are <b>striving to improve the federal hiring process</b> and would like to follow up with you to learn more about your experience since applying. If you would like to help us, <b>please provide your email address</b> so we may send you a short survey at a later date. | Text area, no char limit | N | ||||||
Applicant Background: The information below is voluntary and will be used for statistical purposes only and is strictly confidential | |||||||||
AED12563 | Ethnicity | Hispanic or Latino-a person of Cuban, Mexican, Puerto Rican, South or Central American origin, regardless of race | Radio button, one-up vertical | Single | N | ||||
Not Hispanic or Latino | |||||||||
AED12564 | Race (check all that apply) | American Indian or Alaska Native -a person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment | Checkbox, one-up vertical | Multi | N | ||||
Asian -a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Phillipine Islands, Thailand, or Vietnam | |||||||||
Black or African American - a person having origins in any of the black racial groups of Africa | |||||||||
Native Hawaiian or Other Pacific Islander - a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands | |||||||||
White - a person having origins in any of the original peoples of Europe, the Middle East, or North America | |||||||||
AED12565 | Disability: A person is disabled if he or she has a physical or mental impairment which substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment. | I do not have a disability. | Drop down, select one | Single | N | ||||
Deaf | |||||||||
Blind | |||||||||
Missing extremities | |||||||||
Partial paralysis | |||||||||
Complete paralysis | |||||||||
Convulsive disorder | |||||||||
Mental retardation | |||||||||
Mental or emotional illness | |||||||||
Severe distortion of limbs and/or spine | |||||||||
I have a disability, but it is not listed. |
Measure Name: | MOCK Completer v3 | ||||||||
MID: | U0shQ49o8tlopdN9Nc0RZA== | ||||||||
Completer Survey, cont. | |||||||||
Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | ||
EDO02546 | How long did it take you to finish your application? | Less than one hour | Radio button, one-up vertical | ||||||
1-2 hours | |||||||||
3-4 hours | |||||||||
More than four hours | |||||||||
EDO02547 | What documents were you required to submit for this position? | Resume only, no other documents | Radio button, one-up vertical | Single | Y | ||||
A resume and an assessment questionnaire | |||||||||
Other, please specify | A | ||||||||
EDO02548 | A | Other_documents submitted | Text area, no char limit | N | |||||
AED12560 | How do you feel the Federal job application process compares to private sector job application processes? | Federal job application process is more cumbersome. | Radio button, two-up vertical | Single | Y | ||||
Federal job application process is less cumbersome. | |||||||||
Federal job application process and private sector job application process are about the same. | |||||||||
EDO02549 | What is your number one reason for applying for this position with the Federal government? (Choose only one answer) | Salary | Radio button, one-up vertical | Single | Y | ||||
Career advancement opportunities | |||||||||
Interested in the location of the job | |||||||||
A chance for public service (want to work for the Federal gov't) | |||||||||
Interested in duties of the position | |||||||||
Interested in working for this agency | |||||||||
Flexible schedules, such as tele-work | |||||||||
Other, please specify | A | ||||||||
EDO02550 | A | Please tell us any other reasons you are interested in applying for this position. | Text area, no char limit | N | |||||
ACQOsl0002055 | Do you know how to check the current status of your application? | Yes | Drop down, select one | Single | Y | ||||
No | |||||||||
EDO02551 | Are you currently employed? | Yes | Drop down, select one | Single | Y | ||||
No | |||||||||
EDO02553 | Have you ever worked for the Federal Government? | Yes, I currently work for the Federal government | B | Drop down, select one | Single | Y | Skip Logic | ||
Yes, I have worked for the Federal government but currently do not | |||||||||
No, I have never worked for the Federal government | |||||||||
EDO02556 | B | If yes, what is the highest grade level position you have held with the Federal Government? | GS-1 or equivalent | Drop down, select one | Single | N | Skip Logic | ||
GS-2 or equivalent | |||||||||
GS-3 or equivalent | |||||||||
GS-4 or equivalent | |||||||||
GS-5 or equivalent | |||||||||
GS-6 or equivalent | |||||||||
GS-7 or equivalent | |||||||||
GS-8 or equivalent | |||||||||
GS-9 or equivalent | |||||||||
GS-10 or equivalent | |||||||||
GS-11 or equivalent | |||||||||
GS-12 or equivalent | |||||||||
GS-13 or equivalent | |||||||||
GS-14 or equivalent | |||||||||
GS-15 or equivalent | |||||||||
SES/SL/ST | |||||||||
Don't know | |||||||||
Other, please specify | A | ||||||||
AED12561 | A | Other_highest grade level held | Text area, no char limit | N | |||||
EDO02557 | How did you hear about this job? | I was notified via a USAJOBS automated search agent | Radio button, one-up vertical | Multi | Y | OPS Group | |||
I routinely search USAJOBS | |||||||||
College career service center | |||||||||
Social media (Facebook, Twitter, etc.) | |||||||||
I attended a recruitment event where I met with agency representatives | |||||||||
Visited the agency website | |||||||||
I was referred to the position by an employee of that agency | |||||||||
Agency print ad | |||||||||
Referred by an associate/friend | |||||||||
Found it on another job board or search agent other than USAJOBS | |||||||||
Other, please specify | A | ||||||||
EDO02558 | A | Other_hear about job | Other_hear about job | Text area, no char limit | OpS Group | ||||
EDO02560 | Have you graduated college or obtained your degree within the last two years? | Yes | Drop down, select one | Single | Y | ||||
No | |||||||||
EDO02561 | What is the highest level of education you have attained? | High school diploma | Radio button, one-up vertical | Single | Y | OPS Group | |||
Some college | |||||||||
Technical or vocational degree | |||||||||
Associate Degree | |||||||||
Bachelor's degree | |||||||||
Master's degree | |||||||||
Advanced degree (Ph.D, JD, etc) | |||||||||
Other, please specify | A | ||||||||
EDO02562 | A | Other_level of education | Text area, no char limit | N | OpS Group | ||||
EDO02563 | How many years of experience do you have in your current career field? | 0-2 Years | Radio button, one-up vertical | Y | |||||
3-5 Years | |||||||||
6-10 Years | |||||||||
11-15 Year | |||||||||
More than 15 years | |||||||||
EDO02564 | What Federal grade level position are you applying for today? | GS-1 or equivalent | Drop down, select one | Single | Y | ||||
GS-2 or equivalent | |||||||||
GS-3 or equivalent | |||||||||
GS-4 or equivalent | |||||||||
GS-5 or equivalent | |||||||||
GS-6 or equivalent | |||||||||
GS-7 or equivalent | |||||||||
GS-8 or equivalent | |||||||||
GS-9 or equivalent | |||||||||
GS-10 or equivalent | |||||||||
GS-11 or equivalent | |||||||||
GS-12 or equivalent | |||||||||
GS-13 or equivalent | |||||||||
GS-14 or equivalent | |||||||||
GS-15 or equivalent | |||||||||
SES/SL/ST | |||||||||
Not sure | |||||||||
Other, please specify | |||||||||
AED12739 | A | Other_Federal grade level applying for | Text area, no char limit | N | |||||
EDO02552 | Are you a Veteran | Yes | Drop down, select one | Single | Y | ||||
No | |||||||||
AED12562 | If you could make ONE improvement to this job application process, what would it be? | Better information on what to expect next | Radio button, one-up vertical | Single | Y | OpS Group | |||
Information on when I should expect to hear if I am being considered for the position | |||||||||
Easier to understand job opportunity announcements | |||||||||
Integrate all hiring systems so applicants only have to enter their resume/information one time | |||||||||
No written essays | |||||||||
Better information on how I will be evaluated | |||||||||
Other, please specify | A | ||||||||
EDO02565 | A | Other_improvement | Text area, no char limit | N | OpS Group | ||||
EDO02566 | We are <b>striving to improve the federal hiring process</b> and would like to follow up with you to learn more about your experience since applying. If you would like to help us, <b>please provide your email address</b> so we may send you a short survey at a later date. | Text area, no char limit | N | ||||||
Applicant Background: The information below is voluntary and you provide will be used for statistical purposes only and is strictly confidential | |||||||||
AED12563 | Ethnicity | Hispanic or Latino-a person of Cuban, Mexican, Puerto Rican, South or Central American origin, regardless of race | Radio button, one-up vertical | Single | N | ||||
Not Hispanic or Latino | |||||||||
AED12564 | Race (check all that apply) | American Indian or Alaska Native -a person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment | Checkbox, one-up vertical | Multi | N | ||||
Asian -a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Phillipine Islands, Thailand, or Vietnam | |||||||||
Black or African American - a person having origins in any of the black racial groups of Africa | |||||||||
Native Hawaiian or Other Pacific Islander - a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands | |||||||||
White - a person having origins in any of the original peoples of Europe, the Middle East, or North America | |||||||||
AED12565 | Disability: A person is disabled if he or she has a physical or mental impairment which substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment. | I do not have a disability. | Drop down, select one | Single | N | ||||
Deaf | |||||||||
Blind | |||||||||
Missing extremities | |||||||||
Partial paralysis | |||||||||
Complete paralysis | |||||||||
Convulsive disorder | |||||||||
Mental retardation | |||||||||
Mental or emotional illness | |||||||||
Severe distortion of limbs and/or spine | |||||||||
I have a disability, but it is not listed. |
Measure Name: | MOCK Completer v3 | |||||||||
MID: | U0shQ49o8tlopdN9Nc0RZA== | |||||||||
Completer Survey, cont. | ||||||||||
Skip Logic Label | Question Text | Answer Choices (limited to 50 characters) |
Skip to | Type (select from list) | Single or Multi | Required Y/N |
Special Instructions | |||
EDO02546 | How long did it take you to finish your application? | Less than one hour | Radio button, one-up vertical | |||||||
1-2 hours | ||||||||||
3-4 hours | ||||||||||
More than four hours | ||||||||||
EDO02547 | What documents were you required to submit for this position? | Resume only, no other documents | Radio button, one-up vertical | Single | Y | |||||
A resume and an assessment questionnaire | ||||||||||
Other, please specify | A | |||||||||
EDO02548 | A | Other_documents submitted | Text area, no char limit | N | ||||||
AED12560 | How do you feel the Federal job application process compares to private sector job application processes? | Federal job application process is more cumbersome. | Radio button, two-up vertical | Single | Y | |||||
Federal job application process is less cumbersome. | ||||||||||
Federal job application process and private sector job application process are about the same. | ||||||||||
EDO02549 | What is your number one reason for applying for this position with the Federal government? (Choose only one answer) | Salary | Radio button, one-up vertical | Single | Y | |||||
Career advancement opportunities | ||||||||||
Interested in the location of the job | ||||||||||
A chance for public service (want to work for the Federal gov't) | ||||||||||
Interested in duties of the position | ||||||||||
Interested in working for this agency | ||||||||||
Flexible schedules, such as tele-work | ||||||||||
Other, please specify | A | |||||||||
EDO02550 | A | Please tell us any other reasons you are interested in applying for this position. | Text area, no char limit | N | ||||||
EDO02551 | Are you currently employed? | Yes | Drop down, select one | Single | Y | |||||
No | ||||||||||
EDO02553 | Have you ever worked for the Federal Government? | Yes, I currently work for the Federal government | B | Drop down, select one | Single | Y | Skip Logic | |||
Yes, I have worked for the Federal government but currently do not | ||||||||||
No, I have never worked for the Federal government | ||||||||||
EDO02556 | B | If yes, what is the highest grade level position you have held with the Federal Government? | Drop down, select one | Single | N | Skip Logic | ||||
GS-1 or equivalent | ||||||||||
GS-2 or equivalent | ||||||||||
GS-3 or equivalent | ||||||||||
GS-4 or equivalent | ||||||||||
GS-5 or equivalent | ||||||||||
GS-6 or equivalent | ||||||||||
GS-7 or equivalent | ||||||||||
GS-8 or equivalent | ||||||||||
GS-9 or equivalent | ||||||||||
GS-10 or equivalent | ||||||||||
GS-11 or equivalent | ||||||||||
GS-12 or equivalent | ||||||||||
GS-13 or equivalent | ||||||||||
GS-14 or equivalent | ||||||||||
GS-15 or equivalent | ||||||||||
SES/SL/ST | ||||||||||
Don't know | ||||||||||
Other, please specify | A | |||||||||
AED12561 | A | Other_highest grade level held | Text area, no char limit | N | ||||||
EDO02557 | How did you hear about this job? | I was notified via a USAJOBS automated search agent | Radio button, one-up vertical | Multi | Y | OPS Group | ||||
I routinely search USAJOBS | ||||||||||
College career service center | ||||||||||
Social media (Facebook, Twitter, etc.) | ||||||||||
I attended a recruitment event where I met with agency representatives | ||||||||||
Visited the agency website | ||||||||||
I was referred to the position by an employee of that agency | ||||||||||
Agency print ad | ||||||||||
Referred by an associate/friend | ||||||||||
Found it on another job board or search agent other than USAJOBS | ||||||||||
Other, please specify | A | |||||||||
EDO02558 | A | Other_hear about job | Other_hear about job | Text area, no char limit | OpS Group | |||||
EDO02560 | Have you graduated college or obtained your degree within the last two years? | Yes | Drop down, select one | Single | Y | |||||
No | ||||||||||
EDO02561 | What is the highest level of education you have attained? | High school diploma | Radio button, one-up vertical | Single | Y | OPS Group | ||||
Some college | ||||||||||
Technical or vocational degree | ||||||||||
Associate Degree | ||||||||||
Bachelor's degree | ||||||||||
Master's degree | ||||||||||
Advanced degree (Ph.D, JD, etc) | ||||||||||
Other, please specify | A | |||||||||
EDO02562 | A | Other_level of education | Text area, no char limit | N | OpS Group | |||||
EDO02563 | How many years of experience do you have in your current career field? | 0-2 Years | Radio button, one-up vertical | Y | ||||||
3-5 Years | ||||||||||
6-10 Years | ||||||||||
11-15 Year | ||||||||||
More than 15 years | ||||||||||
EDO02564 | What Federal grade level position are you applying for today? | Drop down, select one | Single | Y | Note addition of OPS group | |||||
GS-1 or equivalent | ||||||||||
GS-2 or equivalent | ||||||||||
GS-3 or equivalent | ||||||||||
GS-4 or equivalent | ||||||||||
GS-5 or equivalent | ||||||||||
GS-6 or equivalent | ||||||||||
GS-7 or equivalent | ||||||||||
GS-8 or equivalent | ||||||||||
GS-9 or equivalent | ||||||||||
GS-10 or equivalent | ||||||||||
GS-11 or equivalent | ||||||||||
GS-12 or equivalent | ||||||||||
GS-13 or equivalent | ||||||||||
GS-14 or equivalent | ||||||||||
GS-15 or equivalent | ||||||||||
SES/SL/ST | ||||||||||
Not sure | ||||||||||
Other, please specify | A | |||||||||
AED12739 | A | Other_Federal grade level applying for | Text area, no char limit | N | ||||||
EDO02552 | Are you a Veteran | Yes | Drop down, select one | Single | Y | Note: this question moved | ||||
No | ||||||||||
AED12562 | If you could make ONE improvement to this job application process, what would it be? | Better information on what to expect next | Radio button, one-up vertical | Single | Y | OpS Group | Note change in question format | |||
Information on when I should expect to hear if I am being considered for the position | ||||||||||
Easier to understand job opportunity announcements | ||||||||||
Integrate all hiring systems so applicants only have to enter their resume/information one time | ||||||||||
No written essays | ||||||||||
Better information on how I will be evaluated | ||||||||||
Other, please specify | A | |||||||||
EDO02565 | A | Other_improvement | Text area, no char limit | N | OpS Group | |||||
EDO02566 | We are <b>striving to improve the federal hiring process</b> and would like to follow up with you to learn more about your experience since applying. If you would like to help us, <b>please provide your email address</b> so we may send you a short survey | Text area, no char limit | N | |||||||
Applicant Background: The information you provide will be used for statistical purposes only and is strictly confidential | ||||||||||
AED12563 | Ethnicity | Hispanic or Latino-a person of Cuban, Mexican, Puerto Rican, South or Central American origin, regardless of race | Radio button, one-up vertical | Single | N | |||||
Not Hispanic or Latino | ||||||||||
AED12564 | Race (check all that apply) | American Indian or Alaska Native -a person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment | Checkbox, one-up vertical | Multi | N | Please check --words are missing, like "Black or African American" and groups are not bolded (Abandoner survey is correct) | ||||
Asian -a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Phillipine Islands, Thailand, or Vietnam | ||||||||||
Black or African American - a person having origins in any of the black racial groups of Africa | ||||||||||
Native Hawaiian or Other Pacific Islander - a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands | ||||||||||
White - a person having origins in any of the original peoples of Europe, the Middle East, or North America | ||||||||||
AED12565 | Disability: A person is disabled if he or she has a physical or mental impairment which substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment. | I do not have a disability. | Drop down, select one | Single | N | |||||
Deaf | ||||||||||
Blind | ||||||||||
Missing extremities | ||||||||||
Partial paralysis | ||||||||||
Complete paralysis | ||||||||||
Convulsive disorder | ||||||||||
Mental retardation | ||||||||||
Mental or emotional illness | ||||||||||
Severe distortion of limbs and/or spine | ||||||||||
I have a disability, but it is not listed. |
File Type | application/vnd.ms-excel |
File Title | Questionnaire Production Guidelines_Template |
Author | Professional Services |
Last Modified By | Katie Phelps |
File Modified | 2019-01-30 |
File Created | 2001-08-03 |