Voluntary Separation - Exit Interview Standard Questionnaire

The Commonwealth of Kentucky is committed to identifying ways to continuously improve the workplace for its employees.  This questionnaire is voluntary and is used to seek feedback from employees leaving the state, which can then be used to enact positive change within agencies.

Note: This questionnaire will not be placed in your official personnel file at the Personnel Cabinet, but will be maintained within the CHFS Office of Human Resource Management.  A questionnaire may be forwarded to third parties if responses warrant additional information or further investigation.

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* 1. Today's Date:

Date

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* 2. Last Name

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* 3. First Name

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* 4. Personnel Number (PERNR)

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* 5. Job Title

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* 6. Agency Name/Number

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* 7. Immediate Supervisor's Name

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* 8. Date of Hire

Date

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* 9. Approximate Length of Service

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* 10. Date of Separation

Date

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* 11. Reason(s) for Voluntary Separation (CHECK ALL THAT APPLY)

For questions 12 - 34, please check the response that best reflects your opinion for EACH question.

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* 12. Overall, I was satisfied with my employment.

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* 13. I knew what was expected out of my performance.

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* 14. After being hired, I did the job I had expected to do, based on the posting and interview process.

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* 15. I received: The information necessary to be successful in my job.

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* 16. I received: The training necessary to be successful in my job.

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* 17. I received: The resources necessary to be successful in my job.

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* 18. I received: the support necessary to be successful in my job.

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* 19. I received: Adequate and timely communication and feedback.

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* 20. I received: Credit for my contributions.

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* 21. I received: Praise for my accomplishments.

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* 22. My office was inclusive and accepting of diversity.

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* 23. My team/co-workers treated me fairly and with respect.

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* 24. My team/co-workers were committed to doing quality work.

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* 25. My ideas and opinions were valued at work.

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* 26. My supervisor: Distributed work fairly/equally

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* 27. My supervisor: Administered discipline fairly.

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* 28. My supervisor: Was helpful.

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* 29. My supervisor: Was knowledgeable in the work and followed policies and procedures.

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* 30. My supervisor: Encouraged professional job development and growth.

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* 31. My supervisor: Worked with staff to resolve problems and to see positive change.

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* 32. My supervisor: Completed my performance evaluations timely, thoroughly and according to administrative regulations and cabinet policy.

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* 33. I would consider working for this agency in the future.

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* 34. I would consider working for a different state agency in the future.

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* 35. Remarks/Comments

In addition to completing this survey, you may  request a telephone interview by contacting the Office of Human Resource Management at 502-564-7770.

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