Date:
Company Name:
Number of Employees:
Number on site:
	Top Person in Charge of Business, Operations, etc.
Name:
Title:
	Person giving the information
Name:
Title:
Address:
City:
State:
Zip:
Phone:
Fax:
eMail:
Business Description:

1. Please check the three areas that are most important to you and your organization.  a.  Difficulty hiring the right people f. Poor work ethic b.  High turnover g. Theft in the workplace c. Poor performance h. Absenteeism d. Legal issues, law suits, union issues i. Drugs and/or alcohol e. Conflict and tension among employees j. Other (please specify)

2. If you could eliminate only ONE of these situations, which one would it be (specify a-j)

3. Why was that your first choice? (Check all reasons that apply).

a.		Very costly	d.		Increases liability and legal risks
b.		High turnover	e.		Other (please specify)
c.		Decreases productivity and profit

4. What are you doing (if anything) to correct this situation?

5. What would fixing this situation save your organization annually (best estimate). $

6. Is there "any" budget for implementing a solution? Yes  No

7. Who authorizes implementation of business solutions?

8. Do you have any testing procedures or systems to evaluate new hires? Yes  No

If yes, what?

9. For promotions? Yes  No

If yes, what?

10.	Does your company have computers?	Yes  No
	Windows 95 or Higher	Yes  No

11.

Have you ever heard of Profiles International, the Step One survey, or Profile?

Yes  No

If yes, please explain: