UNIVERSITY OF DAYTON

EXIT INTERVIEW QUESTIONNAIRE

This form will not become part of your personnel file. Responses will be used solely for addressing turnover and issues associated with maintaining a positive work environment.
If you have questions regarding this form, please call Human Resources at 229-2541.
Name (optional): / Phone:
Department: / Supervisor:
Position Title: / Length of service in years:
1. / Gender: / Female / Male
2. / Race & Ethnicity: / Black / Hispanic / White / Asian/Pacific Islander
American Indian/Alaskan Native / Other:
3. / Please check any of the following which contributed to your decision to leave your current position:
Better job opportunity / Quality of supervision / Attending school
Work environment / Commuting distance / Self-employment
Content of work / Salary / Moving from area
Lack of advancement opportunity / Health / Better fringe benefits
Family circumstances
Other – Please explain:
4. / Please tell us how satisfied you are with UD’s total compensation/benefits package:
5 / 4 / 3 / 2 / 1
Highly / Somewhat / Neutral / Somewhat / Highly / N/A
Satisfied / Satisfied / Dissatisfied / Dissatisfied
a. Rate of pay
b. UD contributions to retirement
plan
c. Tuition remission
d. Medical insurance
e. Life insurance
f. Sick leave/Salary continuation
g. Child care center
h. Wellness Program
i. Employee Assistance Program
j. Long-term disability
k. Short-term disability
Comments:
5. / Please tell us the frequency with which your supervisor exhibited the following actions:
4 / 3 / 2 / 1
Almost Always / Usually / Sometimes / Rarely / N/A
a. Explains policies and procedures:
b. Follows policies and procedures
c. Demonstrates fair and equal treatment
d. Provides recognition on the job
e. Communicates well with subordinates
f. Communicates well with you
g. Cultivates cooperation among team members.
h. Resolves complaints and problems
i. Assists in mentoring and encourages career development
j. Provides new employees with appropriate orientation to the department
k. Remains open to employee ideas and suggestions
Comments:
6. / Please advise us of your experience with the performance management process:
YES / NO
a. Did you receive a current position description when you were employed?
b. Were your job responsibilities fully and correctly explained to you when you were employed?
c. Did you review your position description annually and update as needed?
d. Did you receive coaching and feedback on an annual basis?
e. Did you receive an assessment on an annual basis?
Comments:
7. / Please indicate your level of satisfaction with the work environment in your department:
5 / 4 / 3 / 2 / 1
Highly / Somewhat / Neutral / Somewhat / Highly / N/A
Satisfied / Satisfied / Dissatisfied / Dissatisfied
a. Level of respect and dignity for others as practiced by:
I. Co-workers
II. Supervisor(s)
III. Other employees
IV. Students
b. Friendliness and Cooperation of fellow employees
c. Equipment/technology provided
d. Physical working conditions
e. The department demonstrates commitment to diversity
Comments:
8. / Please indicate your level of satisfaction with the work environment at the University in general:
5 / 4 / 3 / 2 / 1
Highly Satisfied / Somewhat Satisfied / Neutral / Somewhat Dissatisfied / Highly Dissatisfied / N/A
a. Level of respect and dignity for others as practiced by:
I. Co-workers
II. Supervisor (s)
III. Other employees
IV. Students
b. Friendliness and Cooperation of fellow employees
c. Equipment/technology provided
d. Physical working conditions
e. Resolves complaints and problems
f. Recruitment of minority employees and managers is a high priority at UD
g. UD has a tolerance of ethnic and cultural diversity
Comments:
9. / Overall experience at the University of Dayton:
5 / 4 / 3 / 2 / 1
Highly / Somewhat / Neutral / Somewhat / Highly
Satisfied / Satisfied / Dissatisfied / Dissatisfied
10. / Other comments: