Housing and Employment Survey – 2023Q4 Please ensure you meet the following criteria before completing this survey: You are a person forced to register, their representative, or a supportive housing or employment provider. You live or work in Pennsylvania. Resources Form Name Name First First Last Last Address (optional) Address (optional) Street Address Street Address Street Address #2 Street Address #2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Email Phone Please indicate the best answer for you * I am a person forced to register. I am a family/supporter of a person forced to register and am completing this form on their behalf. I am a service provider who would like my listing to be considered for the PARSOL resource directory. I am a concerned citizen that no other option exactly applies to. Note: Questions may be phrased toward the person forced to register, ex: “Does your landlord know you are a person forced to register?” Please list the person’s name you are filling this form out on behalf of. Please list the person's name you are filling this form out on behalf of. First First Last Last Please choose the questionnaires you are willing to respond to questions about. * Housing Employment Housing Resources Choose all that apply: * I have been denied housing solely on the basis of the fact that I am a person forced to register 1-4 times. (Specifically mentioned Megan’s Law etc.) I have been denied housing solely on the basis of the fact that I am a person forced to register 5 or more times. (Specifically mentioned Megan’s Law etc.) I have been denied housing on the basis specifically that I have a criminal record containing a sex offense 1-4 times. (Specifically mentioned Sex Offense.) I have been denied housing on the basis specifically that I have a criminal record containing a sex offense 5 or more times. (Specifically mentioned Sex Offense.) I have been denied housing because I have a criminal record (not specifically a sex offense) 1-4 times. I have been denied housing because I have a criminal record (not specifically a sex offense) 5 or more times. None of these apply. Regarding the housing denial(s) you selected which of these apply? Public Housing Privately Owned Housing Denied Section 8 Benefits Denied residency at a halfway house Person denied housing by LANDLORD based on proxmity to a school, park, etc. Denied housing permission by COUNTY Probation or Parole due to proximity to school, park, etc. Denied housing permission by PA STATE Probation or Parole due to proximity to school, park, etc. Which of these best describes the PFR’s situation? Owns their own home Rents an apartment Leases/Rents a room at a boarding house Leases/Rents a room at a halfway house Stays with family for free (or for minimal contribution) Homeless/Transient Is the person’s landlord open to renting to other PFRs. Yes/Probably No/Probably not Landlord does not know about PFR status Landlord Information Landlord Name: Landlord Phone Number: Landlord Email Address: Property Address: Does landlord own other properties?: Is landlord a management company? If so please describe. Monthly Rent & Number of Bedrooms (Ex. $750/1BR) Do you have any additional comments or thoughts on housing? (If you have had previous welcoming landlords, feel free to list them here.) Employment Resources Choose all that apply: * I have been denied employment solely on the basis of the fact that I am a person forced to register 1-4 times. (Specifically mentioned Megan’s Law etc.) I have been denied employment solely on the basis of the fact that I am a person forced to register 5 or more times. (Specifically mentioned Megan’s Law etc.) I have been denied employment on the basis specifically that I have a criminal record containing a sex offense 1-4 times. (Specifically mentioned Sex Offense.) I have been denied employment on the basis specifically that I have a criminal record containing a sex offense 5 or more times. (Specifically mentioned Sex Offense.) I have been denied employment because I have a criminal record (not specifically a sex offense) 1-4 times. I have been denied employment because I have a criminal record (not specifically a sex offense) 5 or more times. None of these apply. If you have been DENIED EMPLOYMENT, which of these describe those companies? Very Small Business – Less than 10 employees Community/Small Business – 10-99 employees Small Business – 100+ Employees Very Large Company (ex. Amazon, Walmart, etc.) Small Nonprofit Organization – Less than 50 employees Medium Nonprofit Organization – 50-249 employees Large Nonprofit Organization – 250+ employees Restaurant/Hospitality Industry Warehouse If you have been OFFICIALLY EMPLOYED in the past, but are no longer employed by a company because of your background, which describe those companies? Community/Small Business – 10-99 employees Small Business – 100+ Employees Very Small Business – Less than 10 employees Small Nonprofit Organization – Less than 50 employees Medium Nonprofit Organization – 50-249 employees Large Nonprofit Organization – 250+ employees Restaurant/Hospitality Industry Warehouse Which of these best describes your CURRENT situation? Self employed Unemployed Employed at or around my skill/education level Employed below my skill/education level On disability Other Is your company willing to hire other PFRs into qualifying jobs? Yes/Probably No/Probably not Employer does not know about PFR status Employer Information Company Name: Company Website: Company Phone Number: Company Email Address: Company City: Your Job Title/Position: On a scale of 1-10 how understanding of your PFR status/conditions is your employer? Do you have any additional comments or thoughts on employment? (If you have had previous welcoming employers, feel free to list them here.) To validate your form please choose option 6. 1 2 3 4 5 6 7 8 9 10 If you are human, leave this field blank. Submit