Substance Abuse and Mental Health Facility Survey

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* 1. Position Starting Date

Date

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* 2. Position/Title

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* 3. Are you male or female? (or leave blank)

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* 4. Please describe your race/ethnicity. (or leave blank)

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* 5. How did you hear about this position?

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* 6. Please specify which "Online Job Board" if you heard about the position from there.

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* 7. Employee reference name if you heard about this position from someone.

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* 8. Please list title of newspaper, magazine, journal, etc. if you heard about it there.

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* 9. Please specify other if you heard about the job from another source.

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