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Survey in Large Print

 

2010 NM Statewide Employment Survey
 for People with Disabilities

Please respond to the following questions.  Your responses are confidential, so you do not need to provide personal data on the survey.  The results of the survey will be used to assist in eliminating barriers to employment faced by people with disabilities and to improve their employment opportunities.   

THANK YOU FOR YOUR HELP WITH THE SURVEY.

When  you have completed the survey, answering all the questions, please click on the Submit button.  There is one at the bottom of the survey, and also one at the top of the survey.  You may click on either one.  You will receive a confirmation page after you click "Submit".  Thank you.

Note:  If you experience problems with the survey, try using another internet browser.  The survey works best with Internet Explorer, and you may experience difficulties with Firefox or Safari.  Thank you.

 

Please check the box that best describes your employer: 






 


Where are you filling out this survey? 
 








 

2. What is your gender?
 



3.  What is your Race/Ethnicity? 
 






  


4.  Type of Disability 
 






  Learning (i.e. dyslexic)


5.  How would you describe the severity of your disability in terms of limitations on your ability to work? (Check One)
 

 
 
 

6.
 

7.  Where do you live?
 

 
 
 

8.  What is your education level?
 







9.  Have you been employed during the past year (including current employment or including volunteer work)? 
 


If you answered "NO" to question 9, you may proceed to question 19,
skipping questions 10-18.


10.  If "Yes" to #9, please specify what type of employee you are:
 




           


11.  If "Yes" to #9, what was your most recent hourly wage? (Please enter as currency:  example 7.45)
 

 $

12.  If "Yes" to #9, how would you describe your employment?  Check only one:
 

   
     
   
   


  




         


13.  If "Yes" to #9, about how many hours per week do (did) you work?
 






14.  If "Yes" to #9, what was the main type of job you have held?
 













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15.  If "Yes" to #9, for how many months have you been employed in the past year?
 


16.  If "Yes" to #9, which of the following benefits have you received from your job? (check all that apply)
 







17.  If "Yes" to #9, have you asked  your employer for an accommodation because of your disability?
 


    

  

 

18.  If you asked for an accommodation from an employer, was it provided?

 

19.    If "Yes" to #9, do you use assistive technology in your workplace?
 





 

20.  Do you face barriers to employment related to your disability?
 

   

 

 

21.  If you have not worked during the past year, which of the following best describes the reason(s) why.  (check all that apply)
 









     

 



      
  NA, I worked

 

22.  Which of the following types  of public assistance are you receiving? (check all that apply)
 








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If some of the questions did not show, change your browser to Internet Explorer.  There have been some difficulties reported with Firefox and Safari.  Thank you.

If you have questions, please contact

Glenn Damian
Community Resource Associates
office:  505-426-2265
cell phone:  (505) 429-9098
email:  gdamian@nmhu.edu
               

 

THANK YOU!