Employee Name ……………………………………….
Termination/Resignation Date …………………………………..
Employee ID …………………………………..
Eligible for Rehire [ ] Yes [ ] No
Job Title …………………………………........
Reasons for Termination
Voluntary Involuntary
[ ] Another Position [ ] Attendance
[ ] Personal Reasons [ ] Violation of Company Policy
[ ] Relocation [ ] Lay Off
[ ] Retirement [ ] Reorganization
[ ] Return to School [ ] Position Eliminated
[ ] Other ……………………………… [ ]Other ………………………………
Employee Comments:
Interviewer Comments:
Employee Signature……………………………
Date…………………………………………….…….
Interviewer Signature…………………………..
Date……………………………………………………
Questionnaire
1. What are your primary reasons for leaving?
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2. What did you find most satisfying about your job?
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3. What did you find most frustrating about your job?
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4. Were there any company policies or procedures that made your work more
difficult?
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5. Would you consider returning to BGS in the future?
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6. Would you recommend this institution to a friend as a good place to work?
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7. Is there anything the institution could have done to prevent you from leaving?
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8. What did you think of your supervisor on the following points?
Almost Always Usually Sometimes Never
Was consistently fair
Provided recognition
Resolved Complaints
Was sensitive to
employees’ needs
Provided feedback on
performance
Was receptive to open
communication
Followed BGS’ policies
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Questionnaire
9. How do you rate the following?
Excellent Good Fair Poor
Cooperation within your section/department
Cooperation with other departments
Personal job training
Equipment provided (materials, resources,
facilities)
BGS performance review system
BGS’ new employee orientation program
Rate of pay for your job
Career development/advancement opportunities
Physical working conditions
Comments:
10. Was the work you were doing approximately what you expected it would be?
Yes [ ] No [ ]
Comment:
11. Was your workload usually: Too heavy [ ] About right [ ] Too Light [ ]
12. How did you feel about the employee benefits provided by the company?
Excellent Good Fair Poor No Opinion
Medical plan
Vision plan
Sick leave
Retirement plan
Educational assistance
Comments:
13. What suggestions do you have to make BGS a better place to work?
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