PART ONE

Personal information

Name: Educational Qualification: Age: Relationship status: Single/married/divorced/in a relationship

If married, do you have children? Yes / No

General Information
Occupation: _____________________________________________________________ How long have you worked for this company? _________________________________ What previous positions have you held with the company? ________________________ ______________________________________________________________________________ __________________________________________________________________ What is your job title? _____________________________________________________ How long have you held your current position? _________________________________ Briefly describe your work responsibilities (as you would on a resume): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ________________________________________________

PART TWO
Work life Balance
1. Are you satisfied with the working hours, and does it tally with your private life? A. Strongly satisfied B. Satisfied C. Neutral D. Dissatisfied E. Strongly dissatisfied

2. Do you feel that you are able to balance your work life? a. Yes b. No 3. How much time do you spend on domestic activities after office hours? a. Less than 2 hours b. 2-4 hours c. 4-6 hours 4. Do you work long hours, or work over time during holidays? a. Frequently b. Sometimes c. Rarely d. Never 5. If yes for Question number 4, are you compensated well? a. Yes b. No 6. Does your organization take any initiatives to manage your work life balance? a. Yes b. No If yes to for Question number 06, do they; a. b. c. d. Provide flexible work time Provide adequate leave to manage work life balance Provide Job share option (ex: approve job roster change) Allow work from work

If the above initiatives are not provided, brief your suggestions

7. How does the following factors affect your work life balance? Please tick the appropriate box

8. What factors motivate you to work? a. Personal satisfaction b. Financial independence c. Support from family d. Constructive utilization of time e. Any other, specify :

PART THREE
Job Satisfaction
9. Rate your level of job satisfaction a. Not satisfied b. Satisfied c. Extremely satisfied

From Question 10-14 please tick the relevant box 10. General Working Conditions

Not Satisfied Hours worked each week Flexibility in scheduling Location of work Amount of paid vacation time/sick leave offered

Satisfied

Extremely Satisfied

11. Pay and Promotion Potential Not Satisfied Salary Opportunities for Promotion Benefits (Health insurance, life insurance, etc.) Job Security Recognition for work accomplished Satisfied Extremely Satisfied

12. Work Relationships Not Satisfied Relationships with your co-workers Relationship(s) with your supervisor(s) Relationships with your subordinates (if applicable) 13. Use of Skills and Abilities Not Satisfied Opportunity to utilize your skills and talents Opportunity to learn new skills Support for additional training and education 14. Work Activities Not Satisfied Variety of job responsibilities Degree of independence associated with your work roles Adequate opportunity for periodic changes in duties Satisfied Extremely Satisfied Satisfied Extremely Satisfied Satisfied Extremely Satisfied