Instructions: Please complete this questionnaire by filling in the appropriate information or selecting the appropriate option. Your responses will be kept confidential and used for statistical purposes only.
First Name
Last Name
Department ID
Are you comfortable with the following tasks?
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
Prefer not to say
Gender Identity
Male
Female
Non-binary
Prefer not to say
Prefer to self-describe
Ethnicity/Race
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Two or more races
Prefer not to say
Other:
Are you comfortable with the following tasks?
Yes
No
Prefer not to say
Length of Service with Company
Less than 1 year
1-3 years
4-6 years
7-10 years
10+ years
Job Title/Position
Department/Team
Are you comfortable with the following tasks?
Full-time
Part-time
Contract
Work Location
Highest Level of Education Completed
Less than High School
High School Diploma/GED
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
Prefer not to say
Veteran Status
Yes
No
Prefer not to say
Languages Spoken
Gender Identity
Single
Married
Divorced
Widowed
Prefer not to say
Parental Status
Yes
No
Prefer not to say
Thank you for completing this questionnaire.
Questionnaire Template Insight
Please remove this Questionnaire template insight section before publishing.
Note: This is a sample questionnaire and may need to be modified to fit the specific needs of your organization. It is important to ensure that the questions asked are relevant, respectful, and comply with all applicable laws and regulations.
This Employee Demographic Questionnaire is designed to collect data about the composition of a company's workforce. The information gathered is used for several key purposes, all related to understanding and improving the workplace:
Key Purposes & Insights:
Important Considerations and Insights:
In short, this questionnaire is a valuable tool for understanding the composition of a company's workforce and identifying opportunities to promote diversity, inclusion, and a fair and equitable workplace. It allows organizations to move beyond good intentions and use data-driven insights to create positive change.