| 1. How did you find out about the current opportunity? | Newspaper |
| 2. What is the highest level of education you attempted? | College or University |
| 3. Did you graduate? | Yes |
| 4. How many years have you lived in your current city or town? | 3 to 6 years |
| 5. Select the one that reflects your situation | Unemployed |
| 6. If unemployed, how many months have you been unemployed? | 1 |
| 7. If employed, what is your current job title? | |
| 8. If employed, # of years in current job | |
| 9. What are your personal weekly earnings? | $999 or more |
| 10. What do you consider your current weekly earnings to be? | Above average |
| 11. Which of the following occupational groupings would best describe your current occupation? | Management |
| 12. How adequate is your current income level? | Adequate, but want more |
| 13. What is the major reason you are considering changing careers? | Other |
| 14. What is the major reason you are considering a career in management? | Enjoy coaching and developing others |
| 15. What is the longest period of time you worked full time for one organization or in self-employment? | 6 to 9 years |
| 16. What would you rate your chances for advancement at your present job? | You are currently unemployed |
| 17. How many full time jobs have you held in the last 5 years? | 2-3 |
| 18. How many hours a week do you currently work? If you are currently unemployed or employed part time, use your last full time position. | more than 50 hours |
| 19. How many previous management positions have you held? | 4 or more |
| 20. How many years experience do you have in a people management position (i.e., directly managing other people)? | 6 to 9 years |
| 21. In your current or previous management positions, what was the largest number of people that you managed directly? | Greater than 100 |
| 22. Are you bilingual? | No |
| 23. What type of work are you looking for? | Full-time |