Employee Exit Interview Survey
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Which department were you working?
*
Please Select
01 Crisis
02 SMI
04 Transitional Care
05 Public Safety
10 Community Crisis
11 Mesa Fire
12 SNF/ In Home
14 Casa Grande PNP
15 Casa Grande Counseling
16 Scottsdale PNP
17 Scottsdale Counseling
18 Tempe Counseling
19 Tempe PNP
20 Population Health
22 Case Management
24 Estrella Counseling
25 Estrella PNP
30 Gilbert Counseling
31 Gilbert PNP
927 Financing
928 Human Resources
929 Quality Management
930 Information Tech
931 Admin/Exec
933 Revenue Management
934 Client Engagement
What was your job title?
*
Who was your manager?
*
Your final date
*
-
Month
-
Day
Year
Your final date of employment will also be your date of system disconnection and when you turn in your equipment.
Why are you leaving?
*
Now, you can rate your experience working here
How would you describe your work experience with the company?
*
What did you like the most about working for the company?
*
What did you like the least?
*
Did any company policies or procedures (or any other obstacles) make your job more difficult?
*
Did you feel the organization provided sufficient training, opportunities advancement, etc?
*
Do you have any suggestions for ways to make the work pleasant and productive?
Next, you can rate your peers
Did you receive sufficient feedback about your performance?
*
How would you evaluate the performance of your supervisor?
*
My supervisor has been open to, and has acted on, my feedback.
*
1
2
3
4
5
My supervisor has enough technical knowledge.
*
1
2
3
4
5
Overall, the relationship with my supervisor has been good.
*
1
2
3
4
5
Lastly, rate the salary and benefits we offered
Salary
*
1
2
3
4
5
Benefits
*
1
2
3
4
5
Were you happy with your pay, benefits, and other incentives?
And do you have some suggestions for us to improve in this area?
Submit
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