Adult Retention Follow-Up Survey Please take the time to fill out the follow-up survey below. Feel free to call Patricia Thompson at (707) 863-3582 if you have any questions.Follow-up and Contact InformationFirst Name(Required) Last Name(Required) Phone(Required)Email(Required) Are you currently employed?(Required)If yes, you will be asked to complete your current employment and your employer. Yes No Do you need job search assistance?(Required) Yes No Tell us about your employment.Job Title(Required) Average Weekly Work Hours(Required) Hourly/Monthly Wage(Required) Employment Start Date(Required) MM slash DD slash YYYY Employer Name(Required) First Employer Address(Required) Street Address City State / Province / Region ZIP / Postal Code Employer Contact Name First Contact Phone Number(Required)CAPTCHA
