EXIT SURVEY
How Would You Rate Your Working Conditions in the Following Areas?
Excellent
Good
Fair
Poor
N/A
Overall Benefits
5
4
3
2
1
Salary
5
4
3
2
1
Job Security
5
4
3
2
1
Work Schedule
5
4
3
2
1
Flex-Time
5
4
3
2
1
Overtime/Compensatory Time
5
4
3
2
1
Physical Work Conditions
5
4
3
2
1
Work Safety
5
4
3
2
1
Commute To Work
5
4
3
2
1
Please Assess the Following Aspects of Your Work
Excellent
Good
Fair
Poor
N/A
Challenging Job Assignments
5
4
3
2
1
Effective Use of Your Skills
5
4
3
2
1
Reasonable Work Load
5
4
3
2
1
Sense of Purpose
5
4
3
2
1
Sense of Accomplishment
5
4
3
2
1
Ability To Work Freely On Your Own
5
4
3
2
1
Recognition for Good Work
5
4
3
2
1
Availability of Promotional Opportunities
5
4
3
2
1
Training and Development Opportunities
5
4
3
2
1
Management Supports Clear Career Paths within the Organization
5
4
3
2
1
Level Of Job Stress
5
4
3
2
1
Ability To Receive Regular Feedback on Performance
5
4
3
2
1
How Would You Rate Your Work Relationships in the Following Areas?
Excellent
Good
Fair
Poor
N/A
With Co-Workers In Your Unit
5
4
3
2
1
With Immediate Supervisor
5
4
3
2
1
With Higher-Level Managers
5
4
3
2
1
With Staff You Supervised
5
4
3
2
1
With the Customers you serve
5
4
3
2
1
Encouragement of Teamwork and Cooperation within Unit
5
4
3
2
1
Communication within your Unit
5
4
3
2
1
Please Assess Your Organization in the Following Areas
Excellent
Good
Fair
Poor
N/A
Clarity of the Agency Mission
5
4
3
2
1
Organized Work Processes
5
4
3
2
1
Employee Morale
5
4
3
2
1
Communication within your Department/Divsion
5
4
3
2
1
Adherence to Departmental Rules, Policies and Procedures
5
4
3
2
1
Openness to Changes, Suggestions or Ideas
5
4
3
2
1
Resolution of Obstacles, Complaints And Difficulties
5
4
3
2
1
Communication between Agencies
5
4
3
2
1
Performance Evaluation Information
Yes
No
Comments
Did your current PAR/PES accurately reflect the work you do?
1
2
Did you have final Job performance evaluation annually?
1
2
Would you consider working for this employer again?
1
2
Would you recommend this employer as place of employment?
1
2
Would you consider completing a follow-up Exit Survey form 3 to 6 months from now?
What suggestions do you have for overall improvement in:
Your Department
Your Work Group
Your Position
Reason for Leaving
-Select-
Regular Retirement
ERI Retirement
Disability Retirement
Layoff
Advancement Opportunity
Job Dissatisfaction
General Information
Department
-Select-
Agriculture
Banking & Insurance
Board of Public Utilities
Casino Control Commission
Children & Families
Commerce & Economic Development
Community Affairs
Correction
Education
Katzenbach
Environmental Protection
Governor’s Office
Health & Senior Services
Higher Education Student Assistant
Homeland Security
Human Services
Judiciary
Labor & Workforce Development
Law & Public Safety
Legislative Services
Military & Veterans Affairs
Motor Vehicles Commission
Office of Administrative Law
Office Child Advocacy
Office of Information Technology
Office of Public Defender
Personnel
Public Advocate
Public Broadcasting Authority
Public Employment Relation Commission
State
State Colleges & Universities
State Commission of Investigation
State Parole Board
Transportation
Treasury
Division
Unit
Job Title
Years of Service
-Select-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Education
-Select-
High School
Some College
Associates Degree
Bachelors Degree
Masters Degree
Doctorate
Medical Doctor
Certificate
Optional Information
(Information used for Reporting Purposes Only)
Gender (Please Select)
Female
Male
Ethnicity (Please Select)
African-American Asian Hispanic Native American White Other
6
5
4
3
2
1