National Research Staffing - The Nations Leading Specialized Social Research Firm.

Sign Up Questionnaire

Thank you for your interest in becoming a research participant with National Research Staffing. Much of our work involves scientific research studies using groups of research participants to observe presentations and answer questions afterwards. It is important in our work to maintain a large database of a broad cross-section of people from every walk of life in the cities and towns where we work.

Please fill out the following questionnaire completely and then click the “Submit” button at the bottom of the page. All information you give to us will be held in confidence and will never be given out for another purpose. If you are selected for a specific study, we do share your demographic profile with our client and no one else. If you have any question, please feel free to send us an e-mail at pzeller@nationalresearchstaffing.com.

Questionnaire
Name (First, Middle Initial, Last): 
Street address: 
City:  
County/Parish:  
State (2 letters):     Zip:
Daytime Phone:    Area code 
Number 
   Nighttime Phone:    Area code 
Number 
   Cell Phone:    Area code 
Number 
Are you a U.S. Citizen?   Yes No
Are you a Registered Voter?   Yes No
Do you have a drivers license?   Yes No
If So, from what state? 
Have you ever participated in a research study?   Yes No
If So, when? 
How did you hear about us? 
Sex:   Male Female
Date Of Birth (mm/dd/yyyy):    
 Age: 
Occupation 
(If unemployed or retired, what was your previous  occupation?): 
Martial Status:   Married Divorced
  Single Remarried
  Living with someone
Education (highest level completed):  
Do you have children?    Yes No
Spouse Occupation 
(If unemployed or retired, what was your previous  occupation?): 
Ethnic Background: 
Have you ever been convicted in a criminal case involving a felony?   Yes No
If so, please explain: 
Have you ever been a party to a lawsuit?   Yes No
If so, please explain briefly: 
Where you a:   Plaintiff or a Defendant
Have you or anyone close to you ever studied law, or  worked  in a law firm or legal department?   Yes No
If so, please explain:  
Have you, a close friend, or an immediate  family member ever worked, volunteered,  or participated (currently or previously) in  any of these industries, professions, or  organizations? (Please check any and all  that apply)   Market, Opinion, or Polling Research
  Media: TV, Radio, etc.
  Journalism: Newspapers, Magazines, etc.
  Law
  Medical or Health Related Fields
  Insurance
  Childcare
  None of the Above
Your e-mail address: 
 

Back to Top