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What is your gender?
 
Male
 
Female
 
 
 
What is your marital status?
 
Single (Never married)
 
Married
 
Domestic partnership
 
Widowed
 
Divorced
 
Separated
 
Don’t know
 
 
 
What is your favorite hobby or interest?
 
Auto racing
 
Biking
 
Boating
 
Bowling
 
Camping
 
Crafts
 
Dancing
 
Fine Arts
 
Fishing
 
Gambling
 
Gardening
 
Hiking
 
Hunting
 
Horseback riding
 
Kayaking
 
Martial Arts
 
Music
 
Photography
 
Reading
 
Sports
 
Travel
 
Other
 
 
 
What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
How would you rate your level of satisfaction with us?
 
Highly satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
 
 
How would you rate your overall level of satisfaction with us?
 
Highly satisfied
 
Somewhat satisfied
 
Neutral
 
Somewhat dissatisfied
 
Highly dissatisfied
 
Comment:
 
 
 
What are your reasons for leaving this company? (Check all that apply)
 
Higher Pay
 
Benefits
 
Better job opportunity
 
Commute
 
Conflict with other employees
 
Conflict with managers
 
Family and personal reasons
 
Relocation/Move
 
Career Change
 
Company Instability
 
Other

 
 
 
If you have ever offered suggestions to management, how satisfied were you with the response?
 
Never offered a suggestion
 
Not at all satisfied
 
Not very satisfied
 
Somewhat satisfied
 
Very satisfied
 
 
 
Overall, how satisfied are you with the company you work for?
 
Extremely Dissatisfied
 
Very Dissatisfied
 
Neither Satisfied nor Dissatisfied
 
Very Satisfied
 
Extremely Satisfied
 
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