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Why are you leaving the copmpany (Select all that apply)?
 
Other employment
 
Relocation
 
Treatment by management
 
Leaving workforce
 
Ritirement
 
Benefits
 
Other

 
 
 
Please explain your reason(s) for leaving in more detail.
   
 
 
 
What suggestions for improvement do you have for us?
   
 
 
 
If we implemented those suggestions, would you return to work here?
 
Yes
 
No
 
 
 
If you were to return, would you work for the same manager again?
 
Yes
 
No
 
 
 
Would you recommend this company to your friends as a good place to work?
 
Yes
 
No
 
 
Please answer the following:
Strongly disagree Somewhat disagree Somewhat agree Strongly agree
I believe that I was treated like a valuable member of the company
I feel that my immediate supervisor let me know I was doing a good job
I felt free to suggest to my supervisor changes to help department
My job duties and responsibilities were clearly defined
I received the proper training in order to perform my job effectively
Employee problems and complaints were resolved fairly and promptly in my department
I was kept well informed about the company, it's policies and procedures an other important information
I felt that the company provided me job security
 
 
If I had questions or concerns, I felt comfortable speaking with:
Strongly disagree Somewhat disagree Somewhat agree Strongly agree
My immediate supervisor
Upper management
Human Resources
 
 
Please rate the benefits that you received at the company (keeping in mind the benefits offered by other companies that you have worked for):
Poor Fair Good Excellent
Medical
Dental
Parking
Paid Time Off
401(k) plan
 
 
 
Additional comments and suggestions: