Name

Eff. Date

Division:

(Circle the appropriate response.)

Yes

No

1.

Do you feel you were properly placed on your job considering your interest, ability, and schooling?

Y

N

2.

Did you like your job?

Y

N

3.

Do you feel you received adequate training on your job?

Y

N

4.

Do you feel the amount of work which you were asked to perform was fair?

Y

N

5.

Do you believe you received fair pay for the work you were doing?

Y

N

6.

Do you feel the working conditions were good?

Y

N

7.

Do you feel your fellow employees were cooperative?

Y

N

8.

Do you feel you received effective and fair supervision while you were here?

Y

N

9.

Do you feel you were kept properly informed about Department policies and developments?

Y

N

10.

Do you feel the promotional opportunities would have been good had you stayed?

Y

N

11.

Were you satisfied with employee benefits such as sick leave, vacations, retirement plan, medical plan, etc.?

Y

N

12.

If a friend of yours were looking for a job, would you recommend that he apply for work here?

Y

N

13.

What were your most important reasons for leaving?

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