SAMPLE MEMBERS' SURVEY

This survey should be modified to suit your membership.

Part 1: Tell us about yourself

1. • Female
   • Male
2. Age:
   • 16-25
   • 26-35
   • 36-45
   • 46-55
   • 56-65
   • Over 65
3. My first language spoken is:
   • English
   • French
   • Other (Please specify)
4. • I was born in Canada
   • I was born in (Please name country)
5. Union and Local
6. Department
7. City
8. Are you elected to a union position?
   • Yes
   • No
   • If so, please specify
9. Would you describe your job as:
   • Assembly
   • Skilled trades
   • Maintenance
   • Office work
   • Shipping
   • Service
   • Other (please specify)
10. My last level of school finished was:
    • Elementary
    • Some high school
    • Grade 12/High School completion
    • Some college
    • College certificate
    • Some university
    • University degree