Wee Care Center Intake Information Questions 1 - 14 are about YOU Question Title * 1. What is your name? Question Title * 2. What is your home address? Question Title * 3. What is your phone number? Question Title * 4. What is your e-mail address? Question Title * 5. Where do you work? Question Title * 6. What is your hourly wage? Question Title * 7. How many hours a week do you work? Question Title * 8. What days do you typically work> Sunday Monday Tuesday Wednesday Thursday Friday Saturday Question Title * 9. What shift do you work? Day shift (7 am - 3 pm) Second shift (3 pm - 11 pm) Third shift (11 pm - 7 am) Other (please specify) Question Title * 10. How often do you get paid? Weekly Every other week Twice a month Monthly Question Title * 11. Do you go to school? Yes No (skip to question #14) Question Title * 12. Where do you go to school? Question Title * 13. How do you attend school? In person only On-line only Both in person and on-line Question Title * 14. What are you working toward? Certificate (CNA, welding, etc) Associate's Degree Bachelor's Degree Master's Degree Other (please specify) Next