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Name:
   
Department:
   
Job Title:
   
Direct supervisor:
   
 
 
 
Reason for Leaving:
 
Type of Work
 
Returning to School
 
Work Hours
 
Offered Better Position
 
Salary
 
Personal Reasons
 
Supervision
 
Other
 
 
 
How satisfied are you with the following:
Very Satisfied Satisfied Dissatisfied Very Dissatisfied
Use of Skills & Experience
Performance Evaluations
Training Programs
Advancement Opportunities
Salary
Benefits
Supervision
Working Conditions
Overall Experience
 
 
Relationship with the Supervisor
Yes No
Where complaints taken to supervisor?
 
 
If you replied yes to the above question:
Yes No
Were they handled?
 
 
 
Comments/Suggestions:
   
 
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