1. What city do you live in?:

2. What state do you live in?: Select State Not Applicable Alabama laska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

3. What country do you live in?: Select Country Andorra Anguilla Argentina Aruba Australia Austria Bahamas Bahrain Barbados Belgium Bermuda Botswana Brazil British Virgin Islands Brunei Canada Cape Verde Cayman Islands Chile China Costa Rica Croatia Cyprus Czech Republic Denmark Dominican Republic Ecuador Estonia Falkland Islands Fiji Finland France French Guiana French Polynesia Germany Gibraltar Greece Guadeloupe Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Latvia Liechtenstein Lithuania Luxembourg Malaysia Maldives Malta Martinique Mayotte Mexico Montserrat Namibia Netherlands Netherlands Antilles New Caledonia New Zealand Norway Philippines Pitcairn Islands Poland Portugal Qatar Reunion Russia Samoa Singapore Slovakia Slovenia Solomon Islands South Africa South Korea Spain St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon Sweden Switzerland Taiwan Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turks and Caicos Islands Ukraine United Arab Emirates United Kingdom United States Uruguay Venezuela Vietnam Wallis and Futuna Islands

4. What is your job title?:

5. Are you happy in your job?: Yes No Somewhat

6. Have you ever been upset enough with a past or present employer that you would sue?: Yes No

7. Has any of the following happened to you on the job?
    Please check all that may apply:

Physical Mistreatment Verbal Abuse Sexual Harassment Wrongful Termination Wage Dispute

8. List Other Issue(s):

9. If you knew someone was stealing from your employer would you notify the employer?: Yes No

10. Have you ever been approached to give information about your employer?: Yes No

11. If you would like to discuss your work experiences please use this space:

            
                maximum 1000 characters

Please fill in your email address if you would like a copy of the survey results:

Thank you for your time and attention.