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Contact Information
* First Name : 
* Last Name : 
 
 
 
* Today's Date
MonthDayYear
  
 
 
 
Hire Date
MonthDayYear
  
 
 
 
* Last Day of Work
MonthDayYear
  
 
 
 
* Position 
 
 
 
* What is the reason you are leaving Carhartt?
 
Other Employment
 
Personal Reasons
 
Retirement
 
Other- Rather not say
 
Option 5

 
 
 
If you are taking another job, what kind of work will you be doing?
   
 
 
 
What has your new place of employment offered you that is more attractive than your present job?
   
 
 
Please check the box which best describes how you felt about The Company:
Excellent Above Average Average Below Average Poor
* Management and Staff Relations
* Company Communications to Associates
* The Company as a Place to Work
* Working Hours
* Physical Working Conditions
* Your Knowledge of Company and Store Goals
 
 
Please check the box which best describes how you felt about Your Job:
Excellent Above Average Average Below Average Poor
* The job description in relation to your actual job
* The amount of training you received for your position
* The amount of work you were expected to do
* Recognition received for work-related accomplishments
* Your personal sense of accomplishment 
* Your understanding of how your work connects with and impacts Carhartt's vision and mission and how we serve consumers