A. Applicant Role (Your role as applicant)

 
Professor / Academic Researcher (Established)Researcher – PhD candidateResearcher – Master / Bachelor studentBusiness Consultant / HR Manager / CounselorEmployee in a company (internal survey)Government / Ministry administration
If you have another role please specify:
Note: This refers to your role as applicant and contact person, not necessarily the level of the activity or study.

B. Activity / Study Description and Level

 
1. Brief description of the activity, study, or use of JCQ:
Note: Provide a short description of how you plan to use the JCQ instrument. Specify if this is an academic research project, a public sector or ministry survey, an internal company survey, or consulting for clients. Describe your activity or study. If your project is academically led (PhD, Master, or professional research) but conducted in a company, ministry, or other non-university setting, clearly state this context here. This helps JCQ Center Global correctly assess license scope and fees.

2. Activity / Study level (select the level that best describes the activity itself)*:
Academic research (established / institutional)PhD projectMaster’s projectBachelor’s projectProfessional / organizational useConsulting for external clientsNote: Select the professional or academic level of the activity itself, which may differ from your personal role.

C. Sample Size and Use

 
1. Total number of questionnaires to be distributed*:

Note: Enter the total number of questionnaires you plan to distribute, including all copies sent to participants, not only those expected to be completed. Each distribution counts as ‘used’ when first accessed.

2. Expected number of sample used in your activity (completed questionnaires)*:

Note: Estimate how many questionnaire you expect to actually use or receive in your activity. This is separate from the numbers of distributed (see C1).

3. Number of times the JCQ will be administered to the same sample group during this activity*:

Note: If the same group receives the instrument multiple times, indicate how many times. This affects licensing calculations.

4. Sector / type of use*:
Strictly academic research (university or research institution only; no company, consultancy, or government use)Government / Ministry / Public authorityPrivate company (internal use)Consulting / client useNote: Select the sector where the JCQ will be administered. ‘Academic research only’ applies solely to projects conducted within universities or research institutions. If your academically led project takes place in a company or governmental organization, select the corresponding sector here and describe the academic context in Activity / Study Description.

5. Country / countries where the JCQ will be used*:

6. Institution / organization where the JCQ will be used:

7. Expected sample size to be used:

D. Instrument Requested

 
1. Which instrument do you request permission to use?
JCQ / Karasek QuestionnaireJCQ2 / Karasek Questionnaire 2Note: Select which instrument(s) you want to use.

2. If only parts of the instrument are requested, please specify scales and/or items:

E. Publishing and Reproduction

 
1. Will the JCQ results be used strictly for academic research with publication of findings only?*:
YesNo

2. Do you plan to reproduce JCQ items or scales (e.g., in another questionnaire, or products/services etcetera)?*:
YesNo
If yes please explain:
Note: Indicate whether the instrument’s items will only be used for academic reporting, or if you plan to reproduce them in other materials.

F. Language Version

 
Requested language(s) for the JCQ*:
Note: Specify the language version(s) you require for your study.

G. Distribution Method

 
How will the JCQ be administered?*:
Paper and pencilRemote / electronic (online) administrationNote: Choose whether the instrument will be administered on paper or electronically. Remote electronic use requires special permission and may involve additional conditions or fees.

H. License Period

 
1. Planned duration of use / license (months)*:

2. Start (month / year)*:

3. End (month / year)*:

Note: Specify the start and end dates for your license. The license is valid only for this period.

I. Contact and Administrative Information

 
Applicant name and title*:

Designated user / administrator (if different from applicant):

Institution / organization (affiliation of applicant):

VAT / Company ID (if applicable):

Address*:

E-mail*:

Repeat e-mail*:

Note: Provide details of the person submitting the request. If a different person will administer the instrument, include them here.

J. Approve

 
I approve handling*

See Privacy and Data Handling here