| YOUR CONTACT INFO |
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| First Name |
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| Address Line 1 |
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| Address Line 2 |
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| City |
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| Country |
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| Home Phone |
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| Work Phone |
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| Email |
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Each day diarist will be recognized
by name in the book. How would you
like your name to appear in print?
(Please, no pseudonyms.)
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How did you hear about this book
project?
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Preferred method
for receiving information from us:
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How will you
submit your day diary?
(We prefer electronic entries but will accept handwritten submissions.) |
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Please
Sign: I am indicating by my
name below that I would like to participate
in This Day on the Job by creating a day diary on Tuesday, March 27, 2007. Please send me an Instruction
Packet.
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| TELL US
ABOUT YOURSELF |
| Please complete
the questionnaire below. The questions
are designed to give us an understanding
of the diversity of women participating
in the book project. The information
will also be used to help us create
brief profiles of the day diarists featured
in the book. |
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Current Job Status
Category of Primary Occupation
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Place of employment: |
Company Name
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Job Title/Description
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Date of Birth
e.g., 2/16/1965 |
Place of Birth
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Education
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College(s) attended
(if applicable):
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Institution/Degree
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Institution/Degree
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Institution/Degree
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Family Ethnic
Background
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Marital Status
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Number and Ages
of Children
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Significant Other's
Profession
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Do you know of
other women who would like to participate
in this book?
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What labels—positive and negative—do you and society assign to yourself?
(For example, accountant, feminist, boss (or bossy), homemaker, yuppie, slacker, activist, middle class, procrastinator...)
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What do you like best about your job?
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What do you like least about your job?
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What activities or interests are important to you?
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What is the most important thing you'd like others to understand about
you?
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