Employee Name _____________ Department________ Date______
1. Why are you leaving the company? Rank the reasons that apply (start with 1 as the most important).
Pay ___ Job Promotion ___ More convenient hours ___
Co-workers ___ Personal reasons ___ Less responsibility___
More responsibility ___ Type of work___ Supervisor___
Office environment___ Commuting distance___
Other (specify)___________________________________________________
2. If you're going to work for another company, what are they offering you that we are not?
__________________________________________________________
3. Please rate the following as Outstanding (1); Above Average (2); Average (3); or Fair (4):
Quality of our products/services _____
Competence of staff and management _____
Opportunities for advancement _____
Training _____
Compensation and fringe benefits _____
4. Was your workload a problem (too much or too little)?
______________________________________________________
5. Did you have the support (people, equipment, technology) to be as effective as possible?
_______________________________________________________
6. What did you like best about your job?
_______________________________________________________
7. What was most frustrating?
_________________________________________________________
8. In what areas could you have benefited from training?
________________________________________________________
9. Would you recommend our company to prospective employees?
10. Would you recommend our company to potential customers?
________________________________________________________
*Please share any other comments that will help us to be a model employer in the future.
___________________________________________________________
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