RetentionSurvey

Employee Retention Questionnaire

SECTION 1
Professional Background Information
1. How long ago did you leave your prior company? (yy/mm) 2. How long were you employed by your prior company? (yy/mm) 3. How long were you in your final position? (yy/mm) 4. What was your final job title? 5. What is your Occupation? 6. What is your Industry? 7. What is your highest level of formal education?

SECTION 2
Factors Influencing Decision to Leave
Please circle the response which best corresponds to the degree to which each of the following factor influenced or was the reason for your decision to leave 1 = None, 2 = Weak, 3 = Moderate, 4 = Moderate/Strong, 5 = Strong Influence, n/a = Non Applicable
Factors Influencing Decision to Leave Another position / career opportunity Dissatisfaction with pay Lack of recognition Dissatisfaction with benefits Working conditions Quality of supervision Type of work Conflict(s) with co-worker(s) No advancement opportunities Health problems Care for family member Transportation problems

1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4

5 5 5 5 5 5 5 5

n/a n/a n/a n/a n/a n/a n/a n/a

1 1 1 1 2 2 2

3 3 3 3

4 4 4 4

5 5 5

n/a n/a n/a

5 n/a

Vacations/time off Company culture Business/product direction

1 1 1

2 2 2

3 3 3

4 4 4

5 n/a 5 n/a 5 n/a

SECTION 3
Job and Company Environment Activities and Characteristics
Please rate your position with your former employer on the following activities and characteristics 1 =Poor, 2 = Below Average, 3 = Average, 4 = Above Average, 5 = Excellent, n/a = Non Applicable
Company Factors Orientation and Initial Training Ongoing Training Opportunities for Growth and Advancement Appreciation/Recognition Performance Feedback Quality of Supervision Job Expectations vs Reality Working Environment 1 1 1 2 2 2 3 3 3 4 5 n/a 4 5 4 5 n/a n/a

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 5

n/a

4 5 n/a 4 5 4 5 4 n/a n/a

5 n/a

Cooperation Communications Job Satisfaction Salary and Benefits

1 1 1 1

2 2 2 2

3 3 3 3

4 5 n/a 4 5 n/a

4 5 n/a 4 5 n/a

SECTION 4
Individual Performance and Qualifications Related Activities and Characteristics
Please rate yourself compared to others in your former company on the following activities and characteristics 1 =below 50%, 2 = top 50 to 75%, 3 = top 25 to 10%, 4 = top 5 to 10% , 5 = top 5% , n/a = Non Applicable
Individual Factors Overall Performance Quality of Work Quantity of Work Meeting Deadlines Effective Communication Leadership 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a

Teamwork Creativity Initiative Commitment Education Experience

1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a