Form ETA-9124A SCSEP Participant Customer Satisfaction Survey

SCSEP Participant OMB Approval Number: 1205-0040

Customer Satisfaction Survey Expiration Date: 08/31/09

OLDER WORKER CUSTOMERS

Older Worker Program, also known as the Senior Community Service Employment Program (SCSEP), wants to provide the highest quality services to its customers. You can help us improve our services by answering the following questions. Please be completely honest. Your answers will be strictly confidential. No one in the agency will see your individual responses.

Choose the number on the scale below each question that best represents your opinion. Thank you in advance for your help.

1. Utilizing the scale of 1 to 10 below, what is your overall satisfaction with the services provided by the Older Worker Program? (Choose one number)

Very Very Didn't
dissatisfied satisfied receive

1 2 3 4 5 6 7 8 9 10 90

2. Considering all of the expectations you may have had about the services of the Older Worker Program, to what extent have the services met your expectations? (Choose one number)

Falls Exceeds Didn't
short receive

1 2 3 4 5 6 7 8 9 10 90

3. Now, think about the ideal services for people in your circumstances. How well do you think the services you received compare with the ideal services? (Choose one number)

Not at all Very Didn't
close close receive

1 2 3 4 5 6 7 8 9 10 90

4. The Older Worker Program staff told me everything I needed to know about how the program worked. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

4. The Older Worker Program staff understood my employment interests and needs. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

Please continue on other side

ETA-9124 – Part A

(June 2004)

Your responses are confidential, and we appreciate your time and assistance.   This voluntary information has been approved by the Office of Management and Budget under OMB approval number 1205-0040, expiring 08/31/2009.   Without this approval, we would not be able to conduct this survey.   The time needed to complete the survey is estimated to average six (6) minutes.  If you have any comments regarding this estimate or any other aspect of this survey, including suggestions for reducing this burden; please send them to the U.S. Department of Labor, Division of Adult Services, Room S-4203, 200 Constitution Avenue, NW, Washington, DC 20210 (Paperwork Reduction Project 1205-0040).

4. The Older Worker Program helped me obtain the supportive services, such as assistance with transportation, housing or medical care, that I needed to meet my employment goals. (Choose one number)

Strongly Strongly Didn’t need
disagree agree any

1 2 3 4 5 6 7 8 9 10 90

4. Before your community service assignment with your host agency, how much of the training you needed to meet your employment goals did the Older Worker Program give you? (Choose one number)

None of All of Didn’t need
the training the training any

1 2 3 4 5 6 7 8 9 10 90

4. The Older Worker Program helped me obtain a community service assignment that was just right for me. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

9. I understand that I have the right to ask for a different community service assignment if I don’t like the one the Older Worker Program gave me. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

10. Given your transportation situation, was your community service assignment convenient to where you live? (Choose one answer)

Yes No Don’t know

11. There is someone in the Older Worker Program I can talk to when I need to. (Choose one number)

Strongly Strongly Doesn’t
disagree agree apply

1 2 3 4 5 6 7 8 9 10 90

12. During my community service assignment, my host agency gave me the training I needed to be successful in my assignment. (Choose one number)

Strongly Strongly Didn’t need
disagree agree any

1 2 3 4 5 6 7 8 9 10 90

Please continue on next page

13. I feel comfortable at my community service assignment. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

14. Compared to the time before you started working with the Older Worker Program, would you say your physical health is better, worse, or about the same? (Choose one number)

1	2	3	9
Better	Worse	About the same	Don’t know

15. Compared to the time before you started working with the Older Worker Program, how would you rate your outlook on life? (Choose one number)

1	2	3	4	5	9
Much more negative	A little more negative	About the same	A little more positive	Much more positive	Don’t know

16. The pay I receive from the Older Worker Program has made a substantial difference in the
quality of my life. (Choose one number)

Strongly Strongly Don’t
disagree agree know

1 2 3 4 5 6 7 8 9 10 90

17. During my community service assignment, the Older Worker Program pressured me, before I was ready, to leave my community service assignment for unsubsidized employment. (Choose one answer)

Yes No Don’t know

If you have an unsubsidized job, answer Questions 18, 19 and 20, and continue with the rest of the survey. If you do not have an unsubsidized job, skip to Question 21.

18. How much help did Older Worker Program staff give you in finding an unsubsidized job?

(Choose one number)

No A great deal Don’t
help of help know

1 2 3 4 5 6 7 8 9 10 90

19. How much of the skills and training you need for your current job did you gain from your community service assignment? (Choose one number)

None of the Nearly all of the Don’t
skills and training skills and training know

1 2 3 4 5 6 7 8 9 10 90

Please continue on other side

20. Overall, how helpful was your community service assignment(s) in preparing you for success in your current unsubsidized job? (Choose one number)

Not at all Extremely Don’t
helpful helpful know

1 2 3 4 5 6 7 8 9 10 90

21. Would you recommend the services of the Older Worker Program to other older workers? (Choose one number)

Definitely Definitely Don’t
no yes know

1 2 3 4 5 6 7 8 9 10 90

22. What do you think is most valuable about the Older Worker Program?

___________________________________________________________________

___________________________________________________________________

____________________________________________________________________

23. What part of the Older Worker Program do you think is most in need of improvement?

____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Thank you for taking time to complete this survey.

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