Confidential Exit Interview

We would appreciate you taking a few minutes to complete this form as honestly as possible. Your responses are confidential and will not become a part of your personnel file. We believe the information is of vital importance in analyzing the factors attributing to turnover within our school district. Most importantly, thank you for being a member of the Bridgeton Public School staff and please accept our best wishes for success in your future endeavors.

Question Title

* 1. Employee Name:

Question Title

* 2. Position/Title/Location:

Question Title

* 3. Supervisor's Name:

Question Title

* 4. Hire Date:

Question Title

* 5. Last Day of Employment:

Question Title

* 6. Board Approval Date:

Question Title

* 7. Reason for Leaving (What prompted you to seek alternative employment?):

Career opportunity

Different type of work

Compensation

Commuting distance

Working conditions

Retirement

Family circumstances

Self-employment

Health reasons

Return to school

Lack of recognition

No career advancement

Moving out of state

Conflict with supervisor

Conflict with other employee(s)

Quality of supervision

Other (please specify)

Question Title

* 8. Rate your supervisor on the following:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Demonstrated fair and equal treatment.	Demonstrated fair and equal treatment. Strongly Disagree	Demonstrated fair and equal treatment. Disagree	Demonstrated fair and equal treatment. Neutral	Demonstrated fair and equal treatment. Agree	Demonstrated fair and equal treatment. Strongly Agree
Provided recognition on the job.	Provided recognition on the job. Strongly Disagree	Provided recognition on the job. Disagree	Provided recognition on the job. Neutral	Provided recognition on the job. Agree	Provided recognition on the job. Strongly Agree
Developed cooperation and teamwork.	Developed cooperation and teamwork. Strongly Disagree	Developed cooperation and teamwork. Disagree	Developed cooperation and teamwork. Neutral	Developed cooperation and teamwork. Agree	Developed cooperation and teamwork. Strongly Agree
Encouraged/listened to suggestions.	Encouraged/listened to suggestions. Strongly Disagree	Encouraged/listened to suggestions. Disagree	Encouraged/listened to suggestions. Neutral	Encouraged/listened to suggestions. Agree	Encouraged/listened to suggestions. Strongly Agree
Effectively resolved complaints/problems.	Effectively resolved complaints/problems. Strongly Disagree	Effectively resolved complaints/problems. Disagree	Effectively resolved complaints/problems. Neutral	Effectively resolved complaints/problems. Agree	Effectively resolved complaints/problems. Strongly Agree
Followed policies and practices.	Followed policies and practices. Strongly Disagree	Followed policies and practices. Disagree	Followed policies and practices. Neutral	Followed policies and practices. Agree	Followed policies and practices. Strongly Agree
Provided appropriate review of job requirements.	Provided appropriate review of job requirements. Strongly Disagree	Provided appropriate review of job requirements. Disagree	Provided appropriate review of job requirements. Neutral	Provided appropriate review of job requirements. Agree	Provided appropriate review of job requirements. Strongly Agree

Question Title

* 9. Rate how you feel about your rate of pay and the employee benefits provided:

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Base salary.	Base salary. Very Dissatisfied	Base salary. Dissatisfied	Base salary. Neutral	Base salary. Satisfied	Base salary. Very Satisfied
Paid holidays and vacation days.	Paid holidays and vacation days. Very Dissatisfied	Paid holidays and vacation days. Dissatisfied	Paid holidays and vacation days. Neutral	Paid holidays and vacation days. Satisfied	Paid holidays and vacation days. Very Satisfied
Paid sick leave plan.	Paid sick leave plan. Very Dissatisfied	Paid sick leave plan. Dissatisfied	Paid sick leave plan. Neutral	Paid sick leave plan. Satisfied	Paid sick leave plan. Very Satisfied
Retirement plan.	Retirement plan. Very Dissatisfied	Retirement plan. Dissatisfied	Retirement plan. Neutral	Retirement plan. Satisfied	Retirement plan. Very Satisfied
Life insurance plan.	Life insurance plan. Very Dissatisfied	Life insurance plan. Dissatisfied	Life insurance plan. Neutral	Life insurance plan. Satisfied	Life insurance plan. Very Satisfied
Educational credit reimbursement plan.	Educational credit reimbursement plan. Very Dissatisfied	Educational credit reimbursement plan. Dissatisfied	Educational credit reimbursement plan. Neutral	Educational credit reimbursement plan. Satisfied	Educational credit reimbursement plan. Very Satisfied
Medical, dental, and vision insurance plans.	Medical, dental, and vision insurance plans. Very Dissatisfied	Medical, dental, and vision insurance plans. Dissatisfied	Medical, dental, and vision insurance plans. Neutral	Medical, dental, and vision insurance plans. Satisfied	Medical, dental, and vision insurance plans. Very Satisfied

Question Title

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

	Poor	Needs improvement	Neutral	Good	Excellent
Communication within your department.	Communication within your department. Poor	Communication within your department. Needs improvement	Communication within your department. Neutral	Communication within your department. Good	Communication within your department. Excellent
Communication with other departments.	Communication with other departments. Poor	Communication with other departments. Needs improvement	Communication with other departments. Neutral	Communication with other departments. Good	Communication with other departments. Excellent
Communication with your supervisor.	Communication with your supervisor. Poor	Communication with your supervisor. Needs improvement	Communication with your supervisor. Neutral	Communication with your supervisor. Good	Communication with your supervisor. Excellent
Communication within the district.	Communication within the district. Poor	Communication within the district. Needs improvement	Communication within the district. Neutral	Communication within the district. Good	Communication within the district. Excellent
Physical working conditions.	Physical working conditions. Poor	Physical working conditions. Needs improvement	Physical working conditions. Neutral	Physical working conditions. Good	Physical working conditions. Excellent
Morale in your department.	Morale in your department. Poor	Morale in your department. Needs improvement	Morale in your department. Neutral	Morale in your department. Good	Morale in your department. Excellent
Opportunity for advancement.	Opportunity for advancement. Poor	Opportunity for advancement. Needs improvement	Opportunity for advancement. Neutral	Opportunity for advancement. Good	Opportunity for advancement. Excellent
Training you received.	Training you received. Poor	Training you received. Needs improvement	Training you received. Neutral	Training you received. Good	Training you received. Excellent

Question Title

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

Question Title

* 12. What did you like most about your job?

Question Title

* 13. What did you like least about your job?

Question Title

* 14. What does your new job offer that this district does not?

Question Title

* 15. Before deciding to leave, did you check into options that would enable you to stay?

Question Title

* 16. Do you have any suggestions for the district's improvement?

Question Title

* 17. If you have suggestions for improvement, did you present them to your supervisor? If yes, what happened?

Question Title

* 18. Did you feel challenged at work?

Yes

Question Title

* 19. Would you recommend working in our district to a friend? If no, please explain.

Yes

No, because...

Confidential Exit Interview