Questionnaire

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Level of Care Questionnaire

Please fill out the form below

Where do you work?

* 'Where do you work?' is required

What is your job classification?

'What is your job classification?' is required

Are you considering transferring to CDCR to get a raise?

Yes
No

Have vacancies been created in your facility by people taking jobs at CDCR?

Yes
No

How have vacancies affected the care patients receive at your institution? (give examples)

Have there been problems with recruiting at your facility? If yes, please explain

Are you doing the same work as one of the classifications in the Coleman decision? If yes, please describe

Name

Title

First Name *

Last Name *

Suffix

Address

Address 1 *

Address 2

City

State

Postal Code

Country

Home phone

- ###

#### *

Work phone

- ###

#### *

E-mail

@ *

Work e-mail