Employee Exit Survey

How easy was it to get the resources you needed to do your job well at this agency?*

	1	2	3	4	5

1 is Not easy at all, 5 is Extremely easy

How much room for professional growth did you have at this agency?*

	1	2	3	4	5

1 is Not at all, 5 is A great deal

Did you feel valued at the agency?*

	1	2	3	4	5

1 is Not at all, 5 is Very much so

How like are you to recommend this agency to others seeking care or employment?*

	1	2	3	4	5

1 is Not likely at all, 5 is Extremely likely

Based on your experience with the agency, how accessible was your supervisor ?*

	1	2	3	4	5

1 is Not accessible at all, 5 is Extremely accessible

How realistic were the expectations of your supervisor?*

	1	2	3	4	5

1 is Not at all realistic, 5 is Extremely realistic

How often did your supervisor listen to your opinions and suggestions concerning your job responsibilities?*

	1	2	3	4	5

1 is Not often at all, 5 is Extremely often

How well did your supervisor handle and or address your concerns?*

	1	2	3	4	5

1 is Not well at all, 5 is Extremely well

How well prepared were you for your job assignment?*

	1	2	3	4	5

1 is Not well at all, 5 is Extremely well

How effective were your training sessions?*

	1	2	3	4	5

1 is Not effective at all, 5 is Extremely effective

Comments
What additional comments would you like to share about your experience with the agency?
What additional comments would you like to share about your experience with your supervisor?
What addtional comments would you like to share about the training with the agency?
What would you suggest to improve the effectiveness of the training?
If applicable, Where would you like your last paycheck, compensation, settlement and or other necessary information sent?*
Signature*

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