AGE:


COUNTRY:


TOWN:

FAMILY SITUATION (CHOOSE AMONG LIST):
Person living alone Person living alone with dependant children 2 adults under 65 without children 2 adults without children, at least one 65 and more Other households without children 2 adults with 1 child 2 adults, 2 children 2 adults, 3 and more children Other households with children

EMPLOYMENT STATUS (CHOOSE FROM LIST):
Employed full time indefinite contract Employed full time temporary contract Employed part-time indefinite contract Employed part-time temporary contract Unemployed less than 3 months Unemployed more than 3 months Inactive caring for dependent children Inactive caring for dependent adults Disabled Student

PRESENT OCCUPATION (CHOOSE FROM LIST) employed or in last employment in less than one year:
Legislators, senior officials and managers Professionals Technicians and associate professionals Clerks Service workers and shop and market sales workers Skilled agricultural and fishery workers Craft and related trades workers Plant and machine operators and assemblers Elementary occupations Armed Forces

SECTOR OF ACTIVITY (CHOOSE FROM LIST) employed or in last employment in less than one year:
Agriculture, hunting and forestry Fishing Mining and quarrying Manufacturing Electricity, gas and water supply Construction Wholesale and retail trade; repair of motor vehicles, motorcycles and personal and household goods Hotels and restaurants Transport, storage and communication Financial intermediation Real estate, renting and business activities Public administration and defence; compulsory social security Education Health and social work Other community, social and personal service activities Activities of households Extra-territorial organizations and bodies

REASON FOR USING TOOL (CHOOSE FROM LIST):
OFFERED JOB IN ANOTHER EU COUNTRY THINKING OF MOVING HAS ALREADY MOVED SPOUSE OFFERED JOB IN ANOTHER COUNTRY

Which of the following measures related to time flexibility are applicable to your new job/would you like in you have in your new job/ would you like in your present job/ you enjoy in your present job?

Flexible work schedule (8 hours per day with flexibility on the entrance and exit)

Reduced work day (the worker can reduce the workday –to part-time, for example- with a reduction of wages)

Compressed week (more daily hours are worked in exchange for a full or half day free)

Annualised hours (a number of pre-determined hours are worked each year and the total weekly hours can vary depending on the needs of the firm and the worker)

Choice of shifts (in case of shift-work the worker may chose the one preferred)

None of the above: please describe the practice

Point out which of the measures related with flexibility in permits are applicable to your new job/would you like in you have in your new job/ would you like in your present job/ you enjoy in your present job?

Extension of the maternity leave period (a permit longer than legally permitted is allowed without pay but with guarantee of return to the work post)

Extension of the paternity leave period (a longer than legally permitted without pay but with guarantee of return to the work post)

Extension of the holiday period (longer than that prescribed by law or negotiated agreement)

Free time banks (the worker can have more unpaid holiday time)

Flexibility in the holiday period (permissions can be exchanged for holiday time pre-determined by the firm or by negotiated agreement)

The same working conditions and career prospects are maintained for workers on leaves beyond maximum permit times (this varies with respect to the country)

Returning workers are supported on their return from long leaves back into the firm (coaching, training, etc.)

Point out which of the following measures related with flexibility of the workplace are applicable to your new job/would you like in you have in your new job/ would you like in your present job/ you enjoy in your present job?

Work in an office close to the worker’s address (job can be performed in a satellite office in order to avoid commuting)

Work from home (workers can work in their own home to avoid commuting)

Work offices at the worker’s home (the firm provides equipment to the workers such as computer, fax, etc., so that they can work from home exclusively)

Video conferencing (workers can use videoconferencing to avoid travel)

Internet (the firm pays for the cot of Internet in the homes of workers if it is a main tool for their work)

Which of the following measures related to services to dependent persons are applicable to your new job/would you like in you have in your new job/ would you like in your present job/ you enjoy in your present job?

Company provided child-care or crèche (the company offers this service for free or through sharing costs with workers in the company premises)

Chile care or crèche outside the firm (the company offers this service for free or through sharing costs with workers away from the company premises)

Support for child care services (the company covers all or part of cost for the cost of child care)

Services for childcare or child sitting during trips or overtime work (the company covers all or part of the costs of childcare or child sitting when the worker is travelling on company business or working overtime)

Services for the care of dependent adults (the company covers all or part of the costs for care of the worker’s dependent adults)

Please indicate which of the following measures of job adaptation are applicable to your new job/would you like in you have in your new job/ would you like in your present job/ you enjoy in your present job?

Adaptation to the work (the worker continues in the same post, but the responsibility and work load are reduced)

Job rotation (the worker is temporarily assigned a job more adequate to her or his present situation)

Which of the following measures of support or professional and personal orientation are applicable to your new job/would you like in you have in your new job/ would you like in your present job/ you enjoy in your present job?

Career development orientation (in which both job and personal life are considered)

Parenting counselling (training or other type of support)

Family-job conflicts (training or other type of support)

Time management (training or other type of support)

Stress management (training or other type of support)

Conflict management (training or other type of support)

Other(training or other type of support) PLEASE DETAIL

Which of the following social benefits are applicable to your new job/would you like in you have in your new job/ would you like in your present job/ you enjoy in your present job? (NOTE these are above and beyond the legal social benefits)

Medical insurance for partner and/or children

Dental insurance for partner and/or children

Retirement pension plan

Life insurance

Company car

Reimbursement of travel costs during non-work hours

Ticket restaurant

Others PLEASE DETAIL 

Are work and life reconciliation measures important or relevant for…? (Please tick as many of the following as you consider relevant to your case):