1. Name: *
2. Department: *
3. Job Title:
4. Major job responsibilities:
5. Date of Hire:
6. Last day of employment:
7. Reason for leaving your County position: *
8. If leaving for another position, what organization will you be working for?
9. Are you leaving for more pay? *
If yes, new salary:
10. Are you leaving for better benefits? *
If yes, which benefits:
11. Please rate your satisfaction of your county position and what you liked and disliked about working here. (Please select one response for each item). Job Training:
Relationship with co-workers:
Work site:
Working conditions:
Compensation:
Employee Benefits:
Opportunity for advancement:
Flexible work schedule:
Job security:
Supervisor's style:
Organization's philosophy:
Communication with supervisor:
Importance of work to organization:
Good use of abilities:
12. Do you have any suggestions for improving work procedures and/or environment:
13. Please add any other comments you believe will help us improve employee satisfaction:
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