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What is your status?

Pick whichever answer is closest.

I was fired, terminated, and/or laid off I quit, but I felt I had no other choiceConditions became something you could not be expected to put up with Still employed, but I was demoted, suspended, or my pay or hours were cut Still working there, nothing has happened yet On leave, or off work, but not terminated

Why do you believe it happened?

Check anything that applies. If none of it fits, say so — that is a real answer and it is more useful than a guess.

Did you speak up?

I complained about discrimination — being treated worse because of race, sex, age, disability, religion, national origin, pregnancy, sexual orientation, gender identity, or military status I reported sexual harassment I reported something I believed was illegal, fraudulent, or a waste of public money I raised unsafe working conditions I refused to do something I believed was illegal I asked for a disability accommodation, medical leave, or FMLA leave I reported a work injury or filed a workers' compensation claim I filed a complaint with a government agency None of these

Where did you work?

Anywhere in New Mexico El Paso County, Texas Somewhere else in Texas A different state altogether

Describe your former employer

A private company, nonprofit, hospital, or clinicChoose this even if you worked on a military base or a national lab, as long as a private company paid you A city, town, county, or school district A state agency, state department, or public university The federal government, the military, the Postal Service, or a federal courtYour own employer — not the owner of the land you worked on I am not sure