All of us have commitments and responsibilities outside of work. Sometimes it is difficult to manage these and a job.

We are interested in finding out if there are particular areas that cause problems and, if so, to consider what we may be able to do to help make life easier. Please take a few minutes to let us know what is important to you. You need only put your name if you wish. When complete, the questionnaire should be returned to

1. Areas that may cause difficulty

This is a problem Could be a problem now in the future Hours of work Travel to work Holidays/paid time off Unpaid time off Caring for children Caring for adult/adults Other (please add) Not a problem

2. How interested are you in any of the following?

Very interested More flexible working hours Part-time/term time working Job sharing Career break Sources of information & advice (e.g. caring, health, housing) Other (please add) Interested Not interested

3. Personal information
Are you? Male Female

Do you work?

Full time Part-time

How many days each week do you normally work?

Full time If you have a partner, do they work (or study)? Part-time

Do you care for children?

Yes No

If so, number and ages

Under 5 5 - 11 years years

12 years and over

Yes Do you care for older people or adult/s with disabilities? No

4. Comments
Please add any relevant comments or suggestions you have Name (optional) ...............................................