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Check which best describes your feeling about the following aspects of your employment. This information will be kept confidential in that you are not required to put your name on the form.
Very Satisfied Satisfied Dissatisfied
Duties of the job
Training & development programs
Opportunities for advancement
Salary treatment
Benefit programs
Working conditions
Working hours
Co-workers
Supervision
Overall, as a place to work
 
 
 
Gender:
 
Female
 
Male
 
 
 
Department:
   
 
 
 
Reason for Leaving: (Check all that apply)
 
Benefits
 
Better job opportunity
 
Commute
 
Family reasons
 
Not challenged
 
Pay
 
Personal reasons
 
Relocation/move
 
Return to school
 
Supervision
 
Work relationships
 
Health

 
 
 
Additional comments
   
 
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