We would appreciate you taking a few minutes to answer the following questions as honestly as possible. Your individual responses are treated as confidential, and will not become part of your personnel file.

We believe the information is of vital importance and will assist in analyzing our employee retention and turnover. Thank you for your cooperation!

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* 1. Your Name (Optional)

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* 2. Title (Optional)

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* 3. Supervisor (Optional)

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* 4. Region (Optional)

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* 5. Department (Optional)

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* 6. Location (Optional) Example: Day Program, House Name

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* 7. If you left voluntarily, what prompted you to seek alternative employment?

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* 8. What did you think of your supervision in regard to the following?

  Almost Always Sometimes Never
Demonstrated fair and equal treatment
Provided recognition on the job
Developed cooperation and teamwork
Encouraged/listened to suggestions
Resolved complaints and problems
Followed policies and practices

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* 9. How would you rate the following in relation to your job?

  Excellent Good Fair Poor
Cooperation/communication within your department
Communication within the agency as a whole
Morale in your department
Job satisfaction
Training you received
Growth potential
Physical working conditions

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* 10. Was your workload usually:

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* 11. How did you feel about your salary and the employment benefits?

  Excellent Good Fair Poor
Base Salary
Medical Plan
Dental Plan
Vision Plan
403B Plan
Life Insurance
Paid Time Off
STD/LTD Plans

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* 12. Are there any other benefits you feel you should have been offered?

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* 13. How frequently did you get performance feedback?

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* 14. What were your feelings about the performance review process?

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* 15. How frequently did you have discussions with your manager about your career goals?

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* 16. What did you like most about your job and/or this agency?

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* 17. What did you like least about your job and/or this agency?

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* 18. Would you recommend this agency to a friend as a place of work?

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* 19. Please provide any additional information you would like us to know. Your feedback is kept confidential and is only used to identify trends so that business practices may be improved. 

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