Exit Interview Form - CoAction Specialty

Name: ______________________________________________ Date: _____/_____/_____

Position(s)? ________________________________________________________________

We would appreciate it if you would take a few minutes to respond to the questions below. Thank you.

Why are you leaving? _______________________________________________________

_________________________________________________________________________

Would you describe your working relationship (with respect to both your particular job and your relationship with fellow workers) as pleasant or unpleasant?

_________________________________________________________________________

Did you feel that your job was important/significant to the overall operation of XXX?

 Yes  No

Did you feel recognized by your supervisor and/or peers for your accomplishments?

 Yes  No

Are there any particular practices or working conditions that either led to your decision to resign or that you feel are detrimental to a satisfactory working environment? If so, do you have any suggestions on how to eliminate them?

_________________________________________________________________________

Are there any practices or working conditions that you feel are particularly beneficial to an effective working relationship and environment and that should be maintained?

_________________________________________________________________________

Would you care to make any other comments?

_________________________________________________________________________