#131 – REVISED 03/15/2004

EXIT INTERVIEW QUESTIONNAIRE

We would appreciate your taking the time to answer the following questions honestly. Your responses are treated as confidential, and will not become part of your personnel file. The information will assist in analyzing the factors contributing to turnover. Thank you for your cooperation.

NAME: ______

EMPLOYMENT DATE: ______TERMINATION DATE: ______

POSITION:______Location:______

What prompted you to resign/seek alternative employment?

__Type of work__Quality of supervision__Self-employment

__Compensation __Work conditions __Health reasons

__Lack of recognition __Family circumstances

__Career opportunity (Please describe)

______

______

______

__Other (Please specify)

______

______

______

Before making your decision to leave, did you investigate the possibility of a different position within Worthington Libraries?

__Yes __No

If "yes", what positions did you apply for?

______

______

If “no”, why not?

______

______

What did you think of your supervision in regard to the following?

ITEM / ALMOST ALWAYS / SOMETIMES / NEVER
Demonstrated fair and equal treatment /  /  / 
Provided recognition on the job /  /  / 
Developed cooperation and teamwork /  /  / 
Encouraged/listened to suggestions /  /  / 
Resolved complaints and problems /  /  / 
Followed policies and practices /  /  / 

COMMENTS______

______

______

How would you rate the following in relation to your job?

ITEM / EXCELLENT / GOOD / FAIR / POOR
Cooperation within your department /  /  /  / 
Cooperation with other departments /  /  /  / 
Communications in your department /  /  /  / 
Communications within the Library as a whole /  /  /  / 
Communications between you and your manager /  /  /  / 
The training you received /  /  /  / 
Potential for career growth /  /  /  / 
Opportunity for advancement /  /  /  / 

COMMENTS______

______

______

Was your workload usually:

__ Too great__ Varied, but all right__ About right__Too light

COMMENTS ______

______

How did you feel about your salary and the employee benefits provided by the Library?

ITEM / EXCELLENT / GOOD / FAIR / POOR
Salary /  /  /  / 
Medical / Dental / Vision /  /  /  / 
Sick Leave /  /  /  / 
Vacation /  /  /  / 

Are there any other benefits you feel should have been offered?

__Yes__No

If "Yes," what? ______

______

Any other comments on benefits?______

______

How frequently did you get performance reviews? ______

______

What were your feelings about them?_________

______

How frequently did you have discussions with your manager about your career goals?______

______

What did you like most about your job and/or the Library?______

______

What did you like least about your job and/or the Library? ______

______

What does your new job offer that your job with the Library did not? ______

______

Would you recommend the Library to a friend as a place to work?

__Yes, without reservations __Yes, with reservations__No

Additional comments about your job or the Library:______

______

______

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