Dear Constituent:

As your State Representative, it is important for me to know what you are thinking and feeling, especially during these difficult economic times. Therefore, I am kindly requesting that you take a few minutes to complete the attached survey regarding the economic needs of our community. Your answers will provide me with essential information that I can take to Harrisburg and local community leaders to better represent your interests.

As the goal of this survey is to address local community employment issues, the total statistical results of this survey may be shared with community leaders, educational institutions, and local organizations and businesses in order to provide more appropriate services (such as employment, educational training, transportation, etc.) to the public. The results of this survey will be only used in general terms, and like United States Census data, the questions we ask are used only to produce statistics. To protect your privacy, the information that you provide will never be used to identify you individually, and only the total results will be used for statistical purposes.

My staff and I are committed to handling your information responsibly and with respect, and only general statistical information will be shared with community leaders. Your voluntary response to this survey is greatly appreciated.

If you have any questions, please feel free to contact my office at (215) 849-6592. Thank you in advance for your participation.

Sincerely,
John Myers
State Representative
201st Legislative District

1. What best describes your current employment status? (check all that apply):
Full-time employee
Part-time employee
Self employed
Unemployed, collecting benefits
Unemployed, not collecting benefits
Retired
Full-time student
Other

2. What is your current or most recent place of employment?

3. What is your current or most recent job title?

4. Are you currently seeking employment?
Yes, Full-time
Yes, Part-time
No

5. If yes, what type of employment are you seeking? Please be specific with any possible job title (check all that apply):
Retail Trade (specify)

Food Services (specify)

Education (specify)

Government (Federal, state or local) (specify)

Health Care (specify)

Construction (specify)

Green Jobs (specify)

Computer Information Technology (specify)

Other (specify)

6. What is your preferred means of transportation to get to work? (check all that apply):
Personal vehicle (car, motorcycle, etc.)
Public transportation (bus, train, etc.)
Walk
Carpool

7. Do you support government spending in job training and creation?
Yes
No

8. What is your gender?
Male
Female

9. What is your current marital status?
Single
Married
Divorced
Separated
Widowed

10. What is your age group?
18-21
22-30
31-40
41-50
51-64
65 and over

11. What is your annual household income?
Under $20,000
$20,000-$45,000
$45,000-$65,000
$65,000-$90,000
$90,000-$125,000
$125,000 plus

12. Do you have any children?
No
Yes
 If yes, how many are under the age of 18?

 How many children require day care?

13. What is the highest level of education you have completed?
Less than High School or GED
High School Diploma or equivalent
Certificate Program
Associate Degree of equivalent
Bachelors Degree or equivalent
Masters Degree (MA, MS, etc.) or equivalent
PhD or equivalent