| First Name: |
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| Last Name: |
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RACE/ETHNICITY YOU BEST IDENTIFY WITH:
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Asian or Pacific Islander
Black or African American
Hispanic or Latino
Native American or Alaskan Native
White or Caucasian
Multiracial/Biracial
Other
Prefer not to say
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GENDER:
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Man
Woman
Nonbinary
Other
Prefer not to say
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| AGE: |
16-21
22-26
27-34
35-54
55+
Prefer not to say
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| I AM A(N) ____ WORKER |
Hourly
Salaried
Prefer not to say
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MY DEPARTMENT:
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Bakery
Cafe
Driver
Training
Roastery
Service
Warehouse/production
Prefer not to say
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| WHAT LOCATION DO YOU WORK AT? |
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| I AM: |
Full-time
Part-time
Prefer not to say
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| DO YOU CURRENTLY HAVE ANOTHER JOB ALONGSIDE COLECTIVO? |
Yes
No
Prefer not to say
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IF ‘YES”, WHICH IS YOUR MAIN SOURCE OF INCOME?
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Colectivo
Both Colectivo and another job equally
Another job
Prefer not to say
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ARE YOU A STUDENT?
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Yes
No
Prefer not to say
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ARE YOU ENROLLED IN BENEFITS?
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Yes
No
Prefer not to say
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HOW LONG HAVE YOU WORKED FOR COLECTIVO?
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Less than 6 months
1-2 years
2-5 years
5+ years
Prefer not to say
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| DO YOU HAVE CHILDREN, DEPENDENTS, OR OTHER FAMILY MEMBERS THAT AFFECT YOUR WORK SCHEDULE AND AVAILABILITY? |
Yes
No
Somewhat
Prefer not to say
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| RANK THE FOLLOWING, WHICH DO YOU MOST WANT TO SEE CHANGE IN COMPANY WIDE? (RANK 1-10): |
Wages, compensation, overtime & holiday pay
Reviews, promotions and raises
Benefits
Scheduling & hours
Meals & discounts
Discrimination & representation
Discipline
Vacation & sick leave
Safety & certification
Dress code
Prefer not to say
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| SPECIFIC TO YOUR DEPARTMENT OR JOB TITLE PLEASE RANK WHICH OF THE FOLLOWING WOULD MAKE THE MOST IMPACT ON YOUR DAILY WORK LIFE? (RANK 1-14) |
Wages, compensation, overtime & holiday pay
Reviews, promotions and raises
Benefits
Scheduling & hours
Meals & discounts
Discrimination & representation
Discipline
Vacation & sick leave
Safety & certification
Dress code
Guaranteed number of work hours
Minimum show-up pay
Training (example, diversity, de-escalation, implicit bias)
Labor-Management Committee (to address issues and concerns)
Prefer not to say
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| Feel free to comment or expand your answers on any of the questions or issues raised above here: |
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Please add any concerns or issues you are experiencing in your department:
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Do you feel that the company provides a safe and healthy work environment? If not, please explain why:
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| If we were sitting across the bargaining table from management, what would be your most important demand: |
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| If you would like additional updates and are comfortable sharing your contact information, please share your info below, so we can keep in touch: |
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| Phone: |
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| Email: |
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| All responses are equally important and will be tallied whether you choose to share your contact information or not. |
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