APPENDIX B

SURVEY QUESTIONNAIRE

NOTE: This Study is voluntary. There is no negative consequence to you if you do not participate. If you
decide to participate, you may choose to stop at any time and need not to proceed answering the survey
questionnaire should you feel uncomfortable doing so. Participation at most will require only 30 minutes
of your time. Risks from participating are minimal. Your responses will remain confidential, and so, the
researcher will greatly appreciate if you will answer the questions honestly.

1. Participant Code: ______________________________________________________

2. Date of Birth (mmddyy):________________ 3. Age: __________________________
4. Sex: ________________ 5. Place of Residence: _____________________________
6. Place of Birth: ________________________________________________________
7. Educational Attainment: ________________________________________________
8. Previous Offense of Record: _____________________________________________
9. How old were you when you first had trouble with the law? ___________________
10. Were you ever in a child care institution? ______YES ________NO
11. If YES, for how long? ___________________________________________________
12. Do you currently have a job? ___________YES __________NO
13. If YES, what kind of job? ________________________________________________
Is your employment full-time or part-time? _________________________________
Where do you work?____________________________________________________
For how many months have you had this job?
[ ] 1 month or less [ ] more than 12 months
[ ] 2 to 6 months [ ] 7 to 12 months
Is this your first employment? ___________YES __________NO
If NO, kindly list all your previous employment:
_____________________________________________________________________
14. If NO, have you ever applied for a job? _____________________________________
How many times have you tried to apply for a job?
[ ] once [ ] more than twice
[ ] twice [ ] never
Did you ever get interviewed? ___________YES __________NO
List down all the companies you have applied for and got rejected:
_____________________________________________________________________