Usage Request Information Form

Requests to get permission to use JCQ or JCQ2 questionnaire:
We look forward to supplying you with information that will assist you in your research. To obtain permission to use the JCQ and the JCQ2 please fill out the information below. The permission is given for a specific time and project and is a personalized permission for an exact project. Thus please fill out the following information so that you receive permission for your exact project. Please be aware that the exact information for your permission will be printed on the JCQ permission contract and invoice that you will receive. Permission for use of the JCQ and JCQ2 is only valid when you have used our online Usage Request Information Form on our official website here and when you have received a signed contract from us.

We are looking forward to supplying you with the JCQ and research support materials.

Please fill out the following information or the exact project that you are requesting permission to use the JCQ for:





A. Your role in the project where you request permission to use of the JCQ
1. Professor
2. Business Consultant – Counselor or HR Manager
3. Researcher (Established)
3.1 Researcher (Student)
3.2 PhD candidate level
3.3 Master or Bachelor level student
3.3.1 Please write Student identification Number if applicable

B. Sample size and location for the use of the JCQ
1. How many respondents are in your project? (Please be aware that you write the maximum needed size of sample - otherwise if you later need more respondents you need to make a new request)

2. How many times are you applying the JCQ to the same sample in the same project and in this project period that you seek permission to?

3. Are you using the JCQ in a project in the public or private sector?

4. What country is /countries are the project in where you use the JCQ?

C. Publishing of your findings of JCQ items
1. Are you/your group in the project using the JCQ in strictly academic research - and only intend to publish a report of your findings?

2. Are you making a republication of the JCQ or use an item or items to be distributed for institutional publications, as part of another questionnaire, or as a product of a company/ institutional or firm?

D. Name of User and Project and Adress
User name and title/Role in this project:

Project Name:

Institution:

Please write VAT/Company Identification Number if applicable:

Adress:

E-mail Adress:

Repeat E-mail Adress:

Time period of the study the same as the time period of the permission for use of JCQ
How many month:

Starting from month:

Year:

E. Which language version of the JCQ do you request?


F. Do you request: Karasek JCQ, JCQ2 or scales or questions from Karasek questionnaires?

G. Do you request Remote Electronic Use permission (special permission and special conditions and payment)?


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