Leaver form

If you wish to discuss any aspect of this form, please contact the HR team:

All information you provide will be treated in the strictest confidence and will be inputted into a database for analysis. This form will not be kept on your personal file but will be kept for 6 months in the HR Department before being confidentially destroyed.

SECTION 5 Exit Questionnaire (For completion by Employee)

Why did you join the CCG initially? (Tick all that apply)

PromotionCareer Opportunities

PayTUPE

Wanted a job/career within the NHSOther

If other – please add further details / comments below

Reason for Leaving (Tick all that apply)

Dissatisfaction with job role Dissatisfaction with salary or benefits package

No career opportunities/Training opportunities Retirement

Relocation to another geographical area Ill health

Caring for dependent(s) Desire to work in the private sector

Other (please state bellow) Returning to training/education

Next Employment:

If you are going into employment elsewhere upon leaving the CCG, is this employment still within the NHS?

YesNoN/A

Which of the following does your new position offer? Tick all that apply:

Increased salaryBetter benefits package

PromotionMore interesting job

Greater prospectsBetter training and development opportunities

Better work Life BalanceOther comment in below box

Training and Development

Did you attend the Corporate Induction CCG?

YesNo

If yes, how long after your start date?

Were you given an appropriate induction within the Department into your role when you started with the CCG?

YesNo

If no, how could we have improved your induction?

Were you provided with adequate training to do your job when you started with the CCG?

YesNo

If no, how could we have improved the training for you?

Did your job description accurately portray your job role?

YesNo

If no, in what ways did your job role differ from Job Description?

Do you feel that you received adequate support from your line manager including?

Always UsuallyOccasionallyNever

Show fair treatment

Give praise for work

well done

Deal promptly with

Complaints/problem

Give encouragement

and help when needed

Explain the job properly

Inform you as to progress

Know and follow procedures

Listen to suggestions and

criticisms

In the past 12 months have you had an appraisal or formal discussion with your manager regarding your performance and objectives?

YesNo

Did you have a Personal Development Plan?

YesNo

If no, what further Training /Development would you like to have received?

About the CCG

Has working for the CCG been of value to you (e.g. training, development, experience, etc.)?

YesNo

Please explain your answer

What do you think of the communication in the CCG?

Very good ReasonablePoor Very poor

Please explain your reasons if possible bellow

Would you recommend the CCG to others as a place to work?

YesNo

Any Other Comments

Please use the space below to make any additional comments or observations, i.e. Changes to have made you reconsider your decision to leave.

Would you consider returning to work for the CCG?

YesNo

If No please specify

HR USE ONLY

HR to complete below as applicable, this section is for monitoring purposes only.

Interviewed by: ………………………………………………. (Print name)

Face to FaceTelephone Interview

Date: ……………………………… Database updated: ……………………………… (Initials & Date)

MONITORING INFORMATION

The CCG recognises and promote the benefits of a diverse workforce and are committed to treating all employees with dignity and respect regardless of race, gender, disability, age, sexual orientation, religion or belief. It is therefore important for us to monitor the diversity of staff who are leaving the CCG.

Date of Birth: ………………………………………………………………………………………………………..

Gender:Male  Female I do not wish to disclose this

Employment Equality Regulations Please select the option which best describes your sexuality

 Lesbian

 Gay

 Bisexual

 Heterosexual

 I do not wish to disclose this

Please indicate your religion or belief below

AtheismJainismJudaism

BuddhismSikhismHinduism

ChristianityOtherI do not wish to disclose this

Islam

Disability Discrimination Act 1995

The Disability Discrimination Act protects disabled people. This includes people with long term health conditions.

Do you consider yourself to have a disability?

Yes  No I do not wish to disclose this information 

Leaver – May 2016